Hematologist is Recommending Transfusion

So I visited my hematologist today to discuss the high iron saturatin (67%) and he ran a CBC really quickly, among other tests.  My hgb has droped from 8.3 last Thursday to 7.9 today and my HCT is 23.9% today.  He is recommending a transfusion of 2 liters and will confer with my OB to get his take. The hematologist says these numbers might be ok later on in pregnancy, but are not great in the first 12 weeks so he would like to avoid complications if possible.  I suppose that he is right.  He also mentioned I will probably feel 100% better.  That's a great incentive, too as the exhaustion is pretty bad.

Update- My OB and hematologist are not in agreement.  According to my OB, one would expect a level of anemia in a b-thal minor who is pregnant.  But my hematologist, who is very knowledgeable about thal, says, this is true, but the severity of anemia is what concerns him.  The OB says he would be more concerned about severe anemia in later pregnancy, and the hematologist disagrees, saying he wants to prevent pregnancy loss.  Also, my hematologist quoted a recent Israeli study to me that tracked women with thal, and those that were transfused had no problems with delivery, etc.  This guy works with the United Nations on Thal Major cases in the Middle East and India.  I have to go with his opinion, right?

Thanks all!

Alisa

Alisa,

Transfusion is absolutely the right thing to do at this point. You will feel better and stronger and your body will be less stressed. Even though your low blood supply doesn't necessarily directly affect the babies, it does affect your ability to stay healthy during the pregnancy and that can affect them. I think you're in good hands with your hematologist and am sure your doctors will be regularly monitoring your Hb during the pregnancy.

Every thal pregnancy can hopefully lead to better understanding among doctors on how to deal with whatever issues arise and what should be monitored and how often. Doctors in the west are seeing many more cases of thal and thal minor and they are learning what to look for and what steps need to be taken to assure a safe pregnancy.

Alisa, I hadn't asked earlier but I assume your husband has been tested for thal trait.

Thank you, Andy.  That's what I thought you would say.  When there was a disagreement between the docs, my husband said we should get your take on it.  You've pinpointed the problem exactly, lack of understanding.  My hematologist is Middle Eastern and trained there.  My OB is an American, trained here.  He has admitted to me that he has never had a patient with thal.

Yes, my husband and I went through genetic counseling before having our first child.  He was born in Lebanon, so it was imperative.  He does not have thal.  Our little girl, though, does have b-thal minor.

Thank you!!!!!  I feel much better going ahead with the transfusion.

Hi Arubagirl,

I have thalassemia minor, and during my second pregnancy, my hg also fell to levels similar to yours.  The prolonged anemia during my pregnancy caused my spleen to enlarge and I felt exhausted.  I also had placenta previa, and was at high risk of bleeding - so I was transfused once during my pregnancy.  I was a lot more energetic after the transfusion, and much better able to take care of my son.  My hg held very well after the transfusion, so I did not require another one. 

I think that part of the reason the hg seems lower during pregnancy is that the blood volume increases and the hg appears a little lower, the other may be the pregnancy taxing the body - using up more hg. 

I was lucky to have had the transfusion because my placenta did tear at 36 weeks, and I did bleed quite a bit.  After the c-section my hg was 70.   

As you are carrying twins, and it is earlier in your pregnancy I think it is wise to get the transfusion.  I am glad that I did.    Best of luck!!

Sharmin

Hi,

Good luck with the tranfusion.

May I ask what your HG levels were pre-pregnancy?

I'm just trying to get a sense of how much they tend to drop in thal minors.

Again, I hope everything works out okay.

Thanks,
dahlia

Thank you, everyone.  We've decided to go ahead with whatever the hematologist recommends.

Dahlia, the last hb test I had was right after my daughter was born in 7/2004, and it was 10.0 at that time, with a hct of 31.4.