Pregnancy Complications

Hello All!

I wanted to see if anyone could point me in the right direction. I am pregnant with my second child and had HELLP syndrome with the birth my first child earlier this year (these babies will be only 1 year apart). I didn't know if anyone knew where I could get more information about blood pressure and preeclampsia during pregnancy and otherwise as it relates to Thalassemia.

Please let me explain my situation:

I was diagnosed with Beta Thalassemia Minor shortly after I learned to walk after a tachycardia episode.

My Hemoglobin is generally under 11 the highest it has ever been is 11.3, my Hemocrit is usually around 35.  My doctors have never tested my actual iron/ferritin. 

I was pregnant with my first child last winter (winter '07) I had my routine blood work for my pregnancy.  Of course my blood work came back with low hemoglobin so I was told to take additional Iron supplements in addition to the Iron that was already in my prenatals.  I get to my 5th month (28 weeks) and I start to swell. My body is just like a sausage and my skin is stretched tight across my entire body.  I go to my doctor and he says there is nothing they can do because my blood preassure is normal.  Then as my pregnancy progresses I begin to get more swollen (can't wear shoes, I can put hand prints in my skin - its almost like putty) and start to get headaches, really high stomach aches at the top of my belly, blurry vision etc.. I go to my doctor and he says it is nothing because I am not spilling protein and I don't have high blood preassure. Finally at 37 weeks (3 weeks early) I call the doctor (4th time that week) to complain about being so uncomfortable and he lets me go to the hospital. I get to the hospital and I am spilling high protein and my blood preassure is 195/115. I am immediately turned on my side and they begin stroke precautions and try to bring down my blood preasure with some sort of IV.

In most cases (that I have read about) HELLP/Preeclampsia symptoms are caused by hypertension, but, I didn't get the hypertension until after the other symptoms were there for 8 weeks. Is there something that could have caused the other symptoms or compromised my placenta (excess iron?) causing the problems to start there?

I would love your insight and more important I would like to be pointed in the direction of scientific resources on this topic to help me direct my medical care this time around.

THANK YOU ALL!

Hi Expecting#2,

Although it is believed that most thal minors have normal pregnancies, some can have very serious complications, as our member, Courtenay, has experienced. It is best to be prepared and make sure the doctors are prepared for any eventuality. Blood transfusions are occasionally required late in the pregnancy or during delivery and the doctors should be prepared for this.

There is not much information on a connection between thal minor and preeclampsia but I did find one study on Thrombophilia and thalassemia minor at http://www.pulsmedia.ro/article--Clinic-Congenital_thrombophilia_and_minor_thalassemia_in_pregnancy--4790.html

Thrombophilia, also known as the hypercoagulable state, refers to blood clotting disorders, which are often associated with thal. Thrombophilia can cause preeclampsia and if a prior history of preeclampsia exists, it is recommended that the woman be assessed for thrombophilia.

Thrombophilia is responsible for spontaneous abortion and during pregnancy for preeclampsia, intrauterine growth retardation, uteroplacentar apoplexy (abruptio placentae), intrauterine demise, premature birth and venous or arterial thrombosis. Women with presented conditions in medical history should be assessed for thrombophilia.

This should be discussed with your doctor. Low dose aspirin is often the treatment if thrombophilia is suspected. The excess hemolysis (breakdown of red blood cells) that sometimes occurs during the pregnancies of thal minors can be a contributing factor to the clotting disorders. This hypercoagulable state may also be responsible for the problems with the placenta. This is a known problem is some thal minor pregnancies and is a common cause of miscarriage among minors, and should be investigated if suspected.

There may be a reason you did not have high blood pressure at first with HELLP syndrome. It is known that thal minor provides some protection against hypertension, so this may cause some equalizing effect on the high blood pressure. When the HELLP became severe, the BP finally tested high, but a problem may have been growing all along unnoticed because of reliance on BP as the measure of HELLP syndrome. It might be advised to look more for the other symptoms of HELLP syndrome in this pregnancy and not rely solely on BP to determine its seriousness.

Because you are thal minor, your doctor should order iron studies before prescribing iron. Many women do become iron deficient during pregnancy, but blood counts alone will not determine iron deficiency in thal minors. Excess iron can be harmful and should be avoided if possible.

Best wishes during your pregnancy.