To analyze the causes of misdiagnosis of thalassemia to improve its recognition and accurate diagnosis.

The clinical manifestations of four cases of thalassemia were retrospectively analyzed, and the difference between thalassemia and iron deficiency anemia was explored.

All four cases were diagnosed as iron deficiency anemia initially. After iron supplementation was ineffective, three cases was finally diagnosed as β-thalassemia and one as iron deficiency anemia combined with α-thalassemia.

Thalassemia is easy to be misdiagnosed clinically. When the treatment of iron supplementation for microcytic hypochromic anemia is ineffective, the possibility of thalassemia should be considered.