This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Thalassemia, Subject name: Medicine
All are seen in Thalassemia major EXCEPT 
Select and explain. 
A. Macrocytic anemia, B. Transfusion dependency, C. Hepato-splenomegaly, D. Target cells
A: Macrocytic anemia
Answer: A: Macrocytic anemia 
Explanation: Ans.(a) Macrocytic anemiaRef: Harrison 19th ed. / 637* Thalassemia major is a hemolytic anemia where defective RBC s are produced resulting in transfusion dependency since the defective RBC s are destroyed by the spleen. These defective RBC in blood circulation are referred to as target cells on a peripheral smear.* The type of anemia seen is referred to as Microcytic Hypochromic anemia.* The Hematopoiesis that occurs in liver and spleen in these patients is referred to as extramedullary hematopoiesis and is responsible for spleno-hepatomegaly in these patients.* IOC for thalassemia is hemoglobin electrophoresis and definitive treatment is bone marrow transplantation.* For survival however Packed RBC are required on regular basis and thus these patients are called transfusion dependant.