The blue dilemma: a rare presentation of dual hemoglobinopathy in a pregnant patient

Methaemoglobinaemia is a rare disorder due to an increase in the amount of a variant of haemoglobin known as methaemoglobin (MetHb), which decreases the oxygen-carrying capacity of blood. It is usually caused by enzyme deficiency. Hb Q India is another rare alpha-chain variant haemoglobinopathy. A young primigravida was referred due to low oxygen saturation. She was otherwise asymptomatic. Patient was received with peripheral cyanosis and in a tachypneic state due to advanced labour. On the pulse oximeter, oxygen saturation was found to be 40%; hence, the patient was immediately intubated, and instrumental delivery was conducted. A detailed workup showed high MetHb levels, and the Hb Q India variant was detected on HPLC. We present this case report of dual haemoglobinopathy, which can pose a great diagnostic dilemma. Methaemoglobinaemia is usually an asymptomatic disease and is managed conservatively, but if symptomatic, it requires intensive management to avoid fatality.