this patient 2 year old presented with swelling of frontal | Figure 1

Case Overview

This patient, a 2-year-old, presented with swelling of the frontal bone on one side, with no signs of inflammation and no history of trauma. No previous past history or surgery. Birth History: The baby was born at 7 months. Other history unremarkable. Exam: normal CBC shows MCV of 65 and Hb of 7.4, others were normal. This is the skull X-ray above. Any differential diagnosis and management, or any abnormalities on the X-ray?

A 43-year-old woman who presents with a history of generalized pallor of long evolution, does not know the exact time. Accompanied by weakness and dizziness.
BP: 110/80 mmHg
HR: 89 bpm
FR: 21 rpm
SpO2: 98%
Physical examination revealed paleness in mucous membranes and nail beds. Visceromegaly is not evident on abdominal palpation.
Complete Blood Count:
WBC: 8,960
RBC: 4.42
Hgb: 7.4
HCT: 24.2
VCM: 54.8
HCM: 16.7
With these CBC results, I decided to order reticulocytes, serum iron levels, and ferritin (which she could not afford).
Reticulocytes: 3.3%
Iron level: 84.04 µg/dL
Having these results, iron deficiency anemia is ruled out and thalassemia would remain as a differential diagnosis. What complementary tests can be requested from the patient to confirm or rule out the diagnosis? Or which other diagnosis can you think of? Thank you very much. Marvin Jesús Villanueva Márquez, Honduras.

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