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Commentary 1.

The major haemoglobins detected are likely to be HbS and HbC, i.e. the patient has "HbSC disease". Her pregnancy may be complicated by painful sickle cell crises, and careful supervision will be necessary. The photomicrograph shows numerous target cells, a usual finding in HbS+C heterozygotes. In one corner, diametrically opposite the only neutrophil in the picture, there is a crescent shaped gametocyte of Plasmodium falciparum. The patient's history of exposure to malaria and of any recent antimalarial treatment must be explored without delay.

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Problem 1. Supporting data: A West African visitor to the United Kingdom, in the early weeks of pregnancy. Hb = 9.0g/dl. Routine haemoglobin electrophoresis (Tris buffer, pH 8.9) demonstrates two major variants in roughly equal proportions, one of which overlies the position to which HbA2 normally migrates while the other is level with a point approximately half way between the HbA + HbA2 (normal) control. Note what the photomicrograph of this patient's blood film shows and consider your response to the findings.

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