Two small questions on my blood test

Hello everyone.  I'm so glad to have found this site. 

I just want to share what it's like to be a Beta Thal Minor.

Doctors says ... well, you know what they all say!  "Nothing to worry about!!  Just a carrier"  ...  True... life goes on!   

Growing up was tough, since I sick rather frequently, and had low level of energy, and there are moments where I just feel dizzy and faintly out of a sudden, and had squat and to put my head low between my knees.  Fatigue comes to me everyday 

Now I just turned 30 a few days ago and more tolerant to fatigue but still tire easily.  I do sleep alot, and being a light sleeper myself makes sleeping difficult for me. 

I've joined the gym recently, and just 1 hour of yoga class tires me alot.  There was a day when I did my yoga class in the morning when I woke up still feeling tired, I ended sleeping 2 hours straight once I reached home! 

What's worse is, I'm not sure if this is even related to Beta Thal Minor, I get irritable and my mood gets really low (I feel depressed) just before I get my period. 

I have two questions on my blood test (in blue).  The test was taken 3 years back:

HAEMATOLOGY RESULTS
HB = 10.4 (sorry, forgot to add the dot earlier!)
RBC 4.78
PCV = 0.33
MCV = 69
MCH = 22
MCHC = 315
RDW = 14.5

White cell count = 6.5 x 109/L (sorry, mis-read the numbers, the following numbers are corrected)
Neutrophils = 6.5 64% 4.2 x 10⁹/L
Lymphocytes = 64% (4.2) 25% 1.6 x 10⁹/L
Monocytes = 7% (0.5 x 10⁹/L)
Eosinophils = 4% (0.3 x 10⁹/L)

Platelets = 331

HbA2 = 5.9% (normal is 1.5 – 3.5)
HbF = 1.9% (normal = <1.6)
Hb H inclusion Bodies = not detected

Serum Iron = 28.8 umol/L (normal is 9.0 – 26.0)
There’s a note that says “Blood film is suggestive of iron deficiency). 
(Question:  But since this serum iron is higher than normal, does this really mean I'm iron deficient?)

Total Bilirudin = 23 umol/L (normal <21)
Doctor explained this is why I have a yellow tint in my skin colour. 

Comment:  Results consistent with Beta Thalassaemia Trait
Note:  Co-existent Alpha Thalassaemia trait cannot be fully excluded.  (Question:  What does this mean?)

Film:  There is a mild microcytic hypochromic anaemia.  The red cells show several elliptocytes, several fragmented cells, several target cells and mild polychromasia.  The white cells and platelets appear normal.  The blood film is sugestive of iron deficiency.  Recommended follow up tests include:  Iron studies.

Can anyone enlighten me a little?

Hello and welcome to the family.

I'll try to take these question.

Thal Minor are often mis-diagnosed as iron deficient because of their lower than normal hemoglobin, this particularly shows up if you have a normal routine blood test (like in your case). The best answer is an electrophesis test which would clearly indicate the presence of thal minor. As you may note "Results consistent with Beta Thalassaemia Trait" as a comment in your test which require further testing like the one mentioned above.

The Alpha thalassemia trait can be detected with the same testing, to get the full state of your condition I recommend you should go for electrophesis test.

Also, please note that thal minor vary in condition, i.e. some people lives are effected more than others. You will notice some people may have none of the symptoms you mentioned in your post and some may have worse. There is a varying degree of complexity in thalassemia minor and major as well.

One word of caution for you, if you are going to to have children than make sure your partner is not thal minor, that risk having a thal major child, far complicated condition which requires regular blood transfusion and iron chelation. Keep visiting us and ask questions.

If you have time visit our section link http://www.thalassemiapatientsandfriends.com/index.php?board=21.0 to get some introduction to thalassemia.

The normal range for serum iron is a bit higher than that, 40-180. Your level is actually low, but it would have to be included with the other iron study results to conclude it is iron deficiency. Do you know what your serum ferritin level is? Even if it is low, it is not seriously low and an iron rich diet would be able to raise your level if needed. Alpha isn't excluded but it's very hard to diagnose alpha trait without a special DNA analysis. I don't think anything here indicates alpha. 

The symptoms you report are commonly mentioned here by other minors. As Canadian_Family said, minor varies a lot. You seem to have a high turnover of red blood cells, leading to high bilirubin. Is your spleen enlarged at all? Your reticulocyte count is probably high. It may be of benefit to supplement with folic acid, magnesium and antioxidants, like vitamin E. A diet high in antioxidants may help your red cells resist the oxidation that causes them to be removed by the spleen, thereby prolonging the lives of the red cells. You may also want to follow the posts about carao syrup and see if other members who are using it show any improvement in energy levels.

 

Thal minor affects everyone differently.  It is worthwhile checking to see if you have other deficiencies as well such as vitamin D3 or if you are hypothyroid.  These things are common in the same population that is likely to carry thalassemia. 

Keep posting:)  You'll find great information here!   

Take care:)

Sharmin

Andy, not sure why the range in my report is so different from yours!  My report states the normal range is 9.0 - 26.0, and my reading of 28.8 umol/L is beyond the normal range, hence it's marked bold.   *confused*  maybe the units are different...    never mind 

In addition to my serum iron readings [*Serum Iron - 28.8 umol/L (normal range is 9.0 - 26.0)], there are additional readings that are grouped with the seum iron results:
Transferrin - 2.48 g/L (normal range is 1.80 - 2.70)
T.I.B.C - 55.6 umol/L (normal range is 45.0 - 70.0)
% Saturation - 45% (normal range is 13 - 51)
Ferritin - 23 ug/L (normal range is 10-120)

After thinking real hard and digging around in my house, I found another report.. taken last year with my husband, just before I got married! 

My husband's readings are normal, except his cholesterol  .  He took the electrophoresis test (its written on the report, and I think my 3-year old report is an electrophoresis report, since the new one does not have the additional attachment). 

---

HB = 9.7 (this is even lower than my earlier report) (normal is 115 - 165 g/L)
RBC 4.46
PCV = 0.32
MCV = 72
MCH = 22
MCHC = 302
RDW = 15.1

White blood cell count = 6.3
Neutrophils = 61% (3.8)
Lymphocytes = 31% (2.0)
Monocytes = 3% (0.2)
Eosinophils = 5% (0.3)

Platelets = 251

HbA2 = (this new report does not have the readings for HbA2, HbF and Hb H inclusion bodies).
HbF = -
Hb H inclusion Bodies = -

Serum Iron = (the new report does not have readings for this!!  ).

Film:  There is a moderate microcytic hypochromic anaemia.  The red cells show moderate poikilocytosis and several target cells.  The white cells and platelets appear normal.  The blood film is suggestive of iron deficiency.  Suggest S. Ferritin to confirm Iron deficiency and Hb analysis to exclude thalassaemia.

Total Bilirudin = 18 umol/L (normal <21) (surprisingly, this came out under the normal range in my new report)

Corrected Calcium = 2.04 mmol/L (normal is 2.10 - 2.55) (my old reading was in the normal reading)

Erythrocytes = 10 x 10⁶/L (normal is <10)

---

I'm not sure about enlarged spleen, maybe I dont.  I did take folic acid for sometime (the doctor recommended me to take it last year, after my blood test, because my husband told the doctor he's seen too much of my hair around in the house), and it didnt have any effect on me, but I'll try again, as someone posted earlier, folic acid should be religiously taken!  I'll guess I'll have to get supplements for vit E. 

I started researching on depression and out of the blue, I searched depression and thalassaemia, and I found this site... I happy to know I'm not alone   I dont want to feel tired and depressive most of the time!  By 5 or 6 pm, I already feel tired... low battery...    I just want to be full of energy from daylight to night time!   

Hi kittybunny,

You're right. It is a different unit of measurement. I usually see it as micrograms/dL. So, looking at the iron reports, serum ferritin is on the low end and serum iron is on the high end. The others are normal. It's doubtful you're iron deficient, but this also shows the weakness of iron testing. There is no definitive test for iron deficiency, so this panel of tests is used, but results can still leave some uncertainty.

Film:  There is a moderate microcytic hypochromic anaemia.  The red cells show moderate poikilocytosis and several target cells.  The white cells and platelets appear normal.  The blood film is suggestive of iron deficiency.  Suggest S. Ferritin to confirm Iron deficiency and Hb analysis to exclude thalassaemia.

This doesn't mean you have iron deficiency. The first reaction when red cells are seen as small and deformed, is to check for iron deficiency by prescribing iron supplements, but if there is no improvement and no deficiency is found, thalassemia cannot be excluded as the reason for the small red cells. In your case, the

"moderate microcytic hypochromic anaemia. The red cells show moderate poikilocytosis and several target cells"

is caused by thalassemia trait and not low iron. (The previous report mentioned alpha thal as not being excluded, because it can't be by these tests, but there is nothing that would include alpha either). The electrophoresis would be done to confirm or exclude thalassemia trait. The high HbA2 and HbF both indicate thal trait, along with the other readings.

In addition to the previous mentioned supplements, vitamin D may help with depression and tiredness.