Thalassemia

A 31-year-old male (male sex assigned at birth) with African Caribbean ancestry presents for evaluation of longstanding anemia. He reports being diagnosed around age 11 and taking iron and a multivitamin for years without improvement, stopping about 12 years ago. He works as a warehouse manager with high activity tolerance (walks 3+ miles/day) and denies chest pain, shortness of breath, abdominal pain, melena/hematemesis, easy bruising, or bleeding gums. He is a nonsmoker, denies vaping/drugs, and drinks ~6 beers/week on weekends; he lives in the U.S. since age 10 and has two healthy children.