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A 2-year-old boy is brought to the clinician by his parents due to easy fatigability and growth delay. They recently immigrated to the United States. The mother did not receive any prenatal care in her home country. The child was born at term by a normal vaginal delivery. He is at the 30th percentile for length and below the 10th percentile for weight. Temperature is 37.2°C (98.9°F), pulse is 115/min, respirations are 25/min, and blood pressure is 85/60 mmHg. Abdominal examination shows hepatosplenomegaly. Hematological tests and hemoglobin electrophoresis are obtained:
Which of the following is the most likely diagnosis?
| Laboratory value | Result | Reference Range |
| Hemoglobin (Hb) | 10.8 g/dL | 13.5-17.5 g/dL |
| Hematocrit (Hct) | 32% | 41-53% |
| Erythrocyte count | 5.7 million/mm3 | 4.3-5.9 million/mm3 |
| Hemoglobin A2 (HbA2) | 6.5% | 1.5-3.5% |
| Fetal hemoglobin (HbF) | 93.5% | 0-1% |
| Hemoglobin A (HbA1) | 0% | 96.5-98.5% |
| Hemoglobin S (HbS) | 0% | 0% |
Which of the following is the most likely diagnosis?
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