Thalassemia, Protein C, Protein S and Infarct: Correlation?

Sir, I read the report on an interesting case of beta-thalassemia/ hemoglobin E (b-thal/HbE) by Vineeta et al. with a great interest [1]. Vineeta et al. concluded that “Protein C and Protein S deficiency were the causative factor for developing hemorrhagic infarct in the HbE/ Beta thalassemia patient [1].” In fact, it can be confirmed that there existed a case of a combined genetic disorder between HbE and IVS1-5 mutation. However, the conclusion proposed by Vineeta et al. should be carefully considered. Firstly, a single case report is not a standard report to set any correlation in clinic. A systematic case control study must be performed to get the cause and outcome relationship. Secondly, the hemorrhagic infarct has no doubt related to abnormal Protein C and Protein S, but further referred linkage to b-thalassemia/HbE cannot be directly assumed. There must be a complete proposed biological process based on gene ontology principle to confirm this correlation.