Thal Minor and Elevated Bilirubin count

I am new to this forum, I am 37 and was recently told that I have thal minor, although I have always been told that I had low iron.  My most recent blood work had my hemoglobbin 11.8, hematocrit 39.4, MCV 78.6, MCH 23.6, MCHC 30.0 and my total bilirubin is 2.20.  Again I was always told that my iron was low but never anything about the thal minor until recently and always had the elevated bilirubin which my father also has and we were both told this is called Gilbert's Syndrome.  Can the elevated bilirubin be related to the thal minor? 

I am not sure which of my parents that this comes from, but one of my sons was diagnosed as being thal minor about 6 months old and as everyone else seems to be told, I was told that he just needs to be aware because of the genetic possibilities when he is older.  My other son (20 months old) recently had repeated blood work and I was told that his RBC are small but my pediatrician says it is iron defiency not thal trait and I asked if he was sure that my son does not have the thal trait since my other son does and he said he was sure that it is not.  I am not sure what to believe. 

I seem to have a lot of the same symptoms of a lot of the other thal minor people here, the constant fatigue, irritability but i guess that can come from a lot of things? 

I would appreciate any insight. 

Thanks,
Dee   
       

Hi Dee,

Have you or your children had any tests besides the CBC? Hemoglobin electrophoresis test and iron studies would be more helpful in determining if it is thal trait or iron deficiency anemia. This should really be done for the kids especially to be certain about their carrier state for the future. This is actually extremely important when they are older so it should be done. The electrophoresis would give a much clearer picture based on the percentages of the various types of hemoglobin present.

If hemolysis is taking place it could cause the higher bilirubin level and some thal minors do experience hemolysis. Gilbert's Syndrome is sometimes found with thalassemia, so this could also be the cause. If it is hemolysis, vitamin D and magnesium may be of some help.

Hi Dee,

 

I am a thal minor too and i also experience the symptoms you are talking about,as Andy told you its very important to know about the carrier state of your kids ,because when they grow up and start a family they should know if their partner carries thal trait,both partners with thal minor have a 25% chance of having a thal major baby,it would be better to get Hb Electrophoresis and Iron studies done.

Take care,

Zaini.

My children and I have had the Hemoglobin electrophoresis test done and that is how I was advised that my first son has thal minor and the same with me. (I am not sure if we are beta or alpha?)   My other son had this done also and that was when I was advised that he does not have thal minor but his CBC did show that his MCV, MCH and MCHC are all low.  Would this mean that he is just iron deficient?  I don't think that iron studies were done on any of us.   

Andy, how would you know if hemolysis is taking place?  Does the hemoglobin electrophoresis tell this? 

My first son is now almost seven and I never really thought much about this because I was told other than him being a carrier that there was nothing for us to worry about however I was told back when he was six months old that his hemoglobbin was 9.0, is this low for a boy? 

Thanks to all for your help and suggestions.
   

The reticulocyte count is often used to check for hemoilysis. The reticulocyte count measures the amount of new immature red blood cells and it will increase in response to red blood cell destruction (hemolysis). If you have the electrophoresis results I can review them and tell you what I think. Iron deficiency is not as easily determined as doctors like to think and as a result, many people take iron they do not need. An iron panel is the only way to tell for sure. Hb of 9 is low and does indicate anemia, but which? More information would be needed.

Hi Deesil ,
 

best Regards

Andy, I finally got a copy of my last blood test results from the hemoglobin electrophoresis done in March 2009 and my hemoglobin was 12.1, MCV 79, MCH 26.8, MCHC 34.0, HgbA 98.6, HgbA2 1.4 and the results I have don't mention anything about a reticulocyte count?  How do you know if you are an alpha or a beta carrier?

Next time I go to my famiy doctor for anything I am going to request that they do an iron panel as you have suggested because I was always told to take iron supplements and maybe I don't need them? 

Next time I am at my pediatricians office I will also request a copy of the blood tests done for my sons.  Thanks for all of your help and assistance you provide to everyone on here.  I have bought the wheat grass supplements and feel a little more energy from them, I need to also start taking the folic acid sups.

Thanks,
Davina 

Hi Davina,

my hemoglobin was 12.1, MCV 79, MCH 26.8, MCHC 34.0, HgbA 98.6, HgbA2 1.4

These levels are all on the low borderline of normal. This makes me wonder what has led to the diagnosis of thalassemia trait. Do you know if this is based on a visual examination of the red blood cells? The electrophoresis shows a very normal breakdown, with HbA2 within range and no HbF (fetal hemoglobin) reported. This would not lead to a diagnosis of thal trait. However, if there is a co-existing iron deficient anemia, the HbA2 could be lowered and thal trait would not be as easily diagnosed through electrophoresis. Again, the bilirubin level could be related to Gilbert's Syndrome, so the higher level does not necessarily mean there is any hemolytic anemia at work. Iron panels would at the least, give some clue about your true status. The Reticulocyte Count would also show if red cell production is normal. The retic count is part of a complete blood count (CBC).
http://www.clinlabnavigator.com/Tests/ReticulocyteCount.html

In summary, the reticulocyte count should be one of the initial tests ordered in the investigation of anemia.

Since you have been diagnosed as thal carrier, I suspect it is on the basis of what the red blood cells look like and not just on the blood test results. The ultimate test would be a DNA analysis to see if you carry alpha or beta traits. Alpha trait is almost impossible to diagnose without a DNA analysis. I think the iron studies should be the next step.