New Here- B-Thal minor Pregnant w/Twins & High Iron Question

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New Here- B-Thal minor Pregnant w/Twins & High Iron Question
« on: March 31, 2008, 03:20:32 PM »
Hi everyone.  I just joined this board after finding it last week.  It seems that there is so much helpful advice here.

I am 10+ weeks pregnant with twins after undergoing IVF.  After performing prenatal blood tests, my doctor called last week to tell me my hemoglobin was 8.3 and he wanted to do an iron study.  My results came back showing that my iron is high (268) and saturation is 67%.  I haven't been able to discuss this with my OB yet. I have been exhausted and a bit dizzy, but nothing horrible as I'm still able to function during the day and work and take care of our 3 year old.  The exhaustion really hits in the evenings.  I also have hypothyroidism for which I take 75 mcgs of synthroid.   I  noticed that my prenatal vitamins contain iron (i beleive 30 mg).  I didn't take one yesterday.

I have some questions as I'm terrified. 
(1) Is this high iron and saturation levels going to hurt my babies?
(2) Should I be avoiding all foods with iron? So no chicken, beef, etc? If so, how do I meet my protein requirements?
(3) Is there anything that I can do to get the extra iron out of my system?  I read that I should be taking (extra?) folic acid, B-complex vitamins, vitamin E and wheatgrass tabs.  Would this be on top of prenatal vitamins without iron that i will buy today?

Thank you so much for any help and advice you can offer!!

Alisa

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Offline Andy Battaglia

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Re: New Here- B-Thal minor Pregnant w/Twins & High Iron Question
« Reply #1 on: April 01, 2008, 12:19:54 AM »
Hi Alisa and welcome,

Although your iron is on the high side and most likely the result of supplementation, it should have no effect on the babies. If you wish to read a case study of a thal major with ferritin over 2000 and its lack of effect on her babies, you can do so at

http://www.ncbi.nlm.nih.gov/pubmed/17356394

Quote
Despite elevated iron studies in the mother during both pregnancies, the SI/TIBC of the infants were quite low.
You should replace your vitamin supplement with one that does not contain iron. Your ferritin level is not high enough to be of any concern now but it is a warning to not take iron. You don't need to avoid iron rich foods but supplements will only add to the iron load. Folic acid is necessary in higher doses than what most supplements will contain and a vitamin E supplement might be useful for another reason that I will address in a moment. You can try a couple different supplements to remove excess iron. IP6 is a member of the B vitamin family. Green tea extract is also helpful, as long as it is decaffeinated. Both are iron chelators and strong antioxidants.

It is very important that your doctors be aware of what is called hypercoagulable state during pregnancy. This is a clotting disorder that occasionally happens with thal minor pregnancies, and any signs should be watched for during pregnancy. Clotting can cause a reduction in blood flow to the placenta resulting in miscarriage. I would recommend that you read the threads at

http://www.thalassemiapatientsandfriends.com/index.php?topic=109.0;highlight=hypercoagulable and

http://www.thalassemiapatientsandfriends.com/index.php?topic=1399.0;highlight=hypercoagulable

I will quote this one passage as it is quite important.

Quote
Thrombophilia (hypercoagulable state)  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.

If there is any sign or history of this is can easily be confirmed with testing. Often, a blood thinner like aspirin will be prescribed to help prevent unusual clotting. Vitamin E is also a blood thinner so it should be considered, as it has many other worthwhile qualities. The other thing both you and the doctors should be aware of is the possibility that you may need blood transfusions at some point during pregnancy because your Hb is already fairly low. Folic acid and wheatgrass may help with this, but your Hb should be checked regularly and you should be aware of any sudden changes in your state. Sudden dizziness or fainting can indicate a drop in Hb and should not be taken lightly. Hb can drop significantly in a short period of time in pregnant women, so watch for any signs. Any sudden change in how you feel should be reported to the doctor immediately. I don't mean to scare you as these problems happen in a small minority of thal minors but with your specific situation of carrying twins and also having somewhat low Hb, you need to be aware of any signs that something is wrong so it can be addressed quickly. Intervention can prevent miscarriage. My own anecdotal experience from talking to thal minors moms is that miscarriage is probably far more common than thought in minors. If you read the posts from Courtenay regarding her pregnancy, you will see that proper monitoring and intervention as needed can result in the birth of a healthy child. Courtenay possibly has a second hemoglobin variant besides thal minor that may have contributed to the dangers, but well informed doctors were able to take the proper steps to protect her and her baby.

Again, I don't want to alarm you because most thal minors have normal pregnancies but you do need to be aware of what to look for and what your doctors should know, as it can make a big difference to the outcome of your pregnancy should anything unusual occur. Do not be concerned about adding iron with transfusions as it will only be a few times at most and your iron load is not high enough to cause any damage. An easy source of free iron is needed to nurture a baby so don't worry about iron in your food at this point. After the pregnancy you can be tested again and if your iron is high you can think about lowering your iron intake then. We can advise you on that too if the time comes.

Best wishes and may everything go smoothly.
Andy

All we are saying is give thals a chance.

Re: New Here- B-Thal minor Pregnant w/Twins & High Iron Question
« Reply #2 on: April 01, 2008, 01:26:46 PM »
Andy,
Thank you so much for taking the time to write your response.  My husband and I read your post together last night and felt overwhelming relief.  I made an appointment with a hematologist for today and will discuss many of the items you brought to my attention.  You didn't alarm me at all.  I believe it's best to be armed with as much information as possible.

THANK YOU, again, for a very thorough and helpful response! Alisa

 

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