Plastic bronchitis in beta thalassemia minor

Sir,

I read the case report “Plastic bronchitis in beta thalassemia minor” by Yadav et al.,[¹] and have the following comments:

1. In the second paragraph of the discussion, the authors state “they (thalassemia minor) are known to present variedly, from being asymptomatic to having an acute chest syndrome”. The reference cited for this statement is a case report, which is published in Portuguese language!! Only the abstract is available in English and it does not support the authors’ statement.
2. The last statement of the discussion section states “Association of plastic bronchitis in beta thalassemia minor appears to be due to increased susceptibility to infection in these patients. The references cited are number 6 and 7. However, neither reference mentions that thalassemia minor patients are more susceptible to infections.
3. Anemia can predispose to repeated infections. However, the patient described in the case report did not have anemia. The authors state that the blood hemogram was normal. How did the authors then conclude that plastic bronchitis was caused by thalassemia minor? Thalassemia minor is known to have a high incidence in certain communities. It is possible that the patient may be having both plastic bronchitis and thalassemia minor. However, mere presence of these two conditions does not mean that they have a cause and effect relationship.
4. The authors have not mentioned about pulmonary function tests (asthma), echocardiography heart disease and pulmonary hypertension, sickling test (sickle-cell anemia) and sweat chloride test (cystic fibrosis). These tests are necessary to rule out secondary causes of plastic bronchitis. If the above tests are normal then the patient should be labeled as having plastic bronchitis of idiopathic origin.