طفل عمره سنتان شاحب جداً منذ عمر ٦ أشهر، وبطنه منتفخ، والكبد والطحال كبيران، وعظام الجبهة بارزة. الهيموغلوبين ٦٫٠، والكريات صغيرة. والداه أقارب. ما الأرجح؟

A 2-year-old has been very pale since 6 months of age, with a distended abdomen, large liver and spleen and frontal bossing. Hb 6.0 g/dL with small red cells. His parents are cousins. What is most likely?

1. Pernicious anaemia
2. Acute leukaemia
3. Simple iron-deficiency anaemia
4. Thalassaemia major

Answer: D) Thalassaemia major. Severe anaemia from 6 months with hepatosplenomegaly, facial bone changes and consanguinity indicates thalassaemia major, needing regular transfusion.