Pregnant with Thal minor

I just need a little advice, I'm confused!

I'm 31 and have known that I have Thal minor since I was a child, but I was always told that there's nothing that can be done so it has gone ignored.  I have 3 children already and had no problems.  I am now 12 weeks pregnant and was told my hemoglobin was low 8.2 and to see a hemotologist.  I just had my appt today and I'm even lower 7.5.  I don't know what is normal?  She kept insisting I needed iron but when I protested she did another test and of course I was right.  I will post my test results, please let me know if it makes sense to any of you.  She had me sign tranfusion consent forms and said if my levels drop to 5 thats what they will do, but 5 sounds scary low to me ?

RBC 3.37 LOW
HGB 7.5 LOW
HCT 23.3 LOW
MCV 69.2 LOW
MCH 22.2 LOW
MCHC 32.1 NORMAL
RDW 19.2 HIGH
PLT 176 NORMAL
MPV 9.2 NORMAL

Hi Kim,

I'm glad you insisted on being tested for iron deficiency as iron is no help when not needed and long term supplementation can be harmful if not needed. I hope you also understand the importance of folic acid both because you are pregnant and also because you are thal minor.

You must be feeling fairly tired with such a low Hb. You are just above the level of 7 where thalassemia intermedias are normally transfused. I agree that 5 is scary low, and would suggest you get another opinion on when to transfuse. One or two transfusions during pregnancy isn't uncommon among thal minors and is considered necessary for the mother. You must also be watching for any sudden drops in Hb.

The typical recommendation for transfusion is an Hb of 7 or lower. http://www.traqprogram.ca/Library/bc-guidelines-rbc-nov2003.asp

As a general guide, in normal healthy individuals, a transfusion threshold of 70 g/L is appropriate and leaves some margin of safety over the critical level of 40-50 g/L.

If you type "thalassemia minor pregnancy" into our search engine, you will find several threads concerning possible problems a minor should be aware of during pregnancy. It might be worth the trouble to find another hematologist with some familiarity of thalassemia, although most doctors routinely believe that thal minor causes no problems. I don't think you should wait until your Hb drops to 5 before you transfuse.

Hi Andy,

Thanks for the advice!  I just really don't understand how one can be in the field of hemotology and yet know so little!  I was telling her how exhausted I am (tired doesn't even begin to describe it!) Last week I actually missed 4 days of work because I couldn't even stand up long enough in the morning to get myself ready...... being light headed just took over me. Even now I go through my day with a 'buzzed' feeling.  I called them today letting them know how how I feel and they just advised me to get 'more rest'!  but between working 10hrs a day and having 3 other children, rest is hard to come by.  I'm just not sure what to do.  I looked in my local phone book for a second opinion and of course, my doctor's practice was the only one listed!  I'm going to see what I can find online.  I'm worried about having a transfusion, but also worried about the possibility of feeling worse if my levels drop even more  ??

Hi Kim,

An Hb below 7 is just too low. You may have to insist you get a transfsuion if it drops below that. I think you should also consider wheatgrass tablets or extract to try to help stabilize your Hb level.