{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:49:45Z","timestamp":1782913785308,"version":"3.54.5"},"reference-count":21,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>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.<\/jats:p>\n                  <jats:p>Methaemoglobinaemia is usually an asymptomatic disease and is managed conservatively, but if symptomatic, it requires intensive management to avoid fatality.<\/jats:p>","DOI":"10.1136\/bcr-2025-266921","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:26:02Z","timestamp":1782912362000},"page":"e266921","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["The blue dilemma: a rare presentation of dual hemoglobinopathy in a pregnant patient"],"prefix":"10.1136","volume":"19","author":[{"given":"Krishma","family":"Thakur","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Maharishi Markandeshwar Medical College and Hospital, Solan, HP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Satodiya","sequence":"additional","affiliation":[{"name":"GMCH, Chandigarh, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilpreet Kaur","family":"Pandher","sequence":"additional","affiliation":[{"name":"GMCH, Chandigarh, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Takkar","sequence":"additional","affiliation":[{"name":"GMCH, Chandigarh, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026070106200600000_19.7.e266921.1","unstructured":"Prchal J . 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