Seeking your help

Hello Every One

This is Shahed from Bangladesh. My wife Mou is 29 yrs old and 28 weeks of her pregnancy (First time). When she was 25+ week of pregnancy we found she is a thalassemia patient and her Hb level is 5.8. then according to doctors advice she take her 1st unit of blood at 29/03/09 and 2nd &3rd took 13th & 16th of April 09 accordingly. Next 30/04/09 we are going to visit the Doc. Again after 1st transfusion her hb is 6.5. Her BP is sometime 140-150/80-90. She got her feet water full. Doctor told not to eat read meet and iron rich fruit & vegetable. In this regard I need your valuable suggestion and the name of some fruit and vegetable (Iron free/less iron) she can consume. Her medication is Sardopa (Methyldopa) (for BP), Calbo- D, folic acid, vitamin E. Aristovit B
NB. Rakin is the name of my coming son (Tentative date of coming is 26 june 09)

Hb Capillary Electrophoresis Report

Conc. 6.2 g/dl
Hb A= 7.1%, F=12.7%, E=73.7, A2=6.5%

For Emergency Contact
mshahed@grameenphone.com

Andy, Sharmin, zaini i am trying to draw your attention

Salaamz Shahid, and Welcome aboard!!

Andy and the moderators have been posting at:
http://www.thalassemiapatientsandfriends.com/index.php?topic=2505.0

All the best for your wife's pregnancy and shortly coming son!

Best,
SF

Hello Shahed,

I think you missed this thread where you posted before.

http://www.thalassemiapatientsandfriends.com/index.php?topic=2505.0

Hi Shahed and welcome,

From your PM I learned that your wife is HbE beta thal, which is common in eastern India and Bangladesh. Often this manifests as thal intermedia but of course this can change during pregnancy, and as is the case with your wife, transfusions can become necessary. Hopefully, once she has the child, she will no longer need transfusions. Have you been tested also? This is important as you need to know if there is a possibility your children will be thal majors.

As far as diet, red meats are high in iron and should be kept to a minimum, if at all. Your wife should avoid citrus fruits like oranges and lemons during meals. These fruits can be eaten but they help iron to be absorbed so they should be avoided during meals and instead taken as snacks. The iron from fruits and vegetables is not as easily absorbed as the iron from meats, so not as much caution needs to be taken. High iron veggies likes the dark green vegetables such as spinach should not be eaten in large amounts but it is OK to have them occasionally. The nutritional value of most fruits outweighs the small amounts of iron that they carry and should not be avoided. If you want to give us a list of foods you want to know about, that would help. Fruits like pomegranate and berries are very good sources of many vitamins and minerals and are also good antioxidants. Your wife would also be advised to take a B complex vitamin, as this helps build blood cells. As Narendra has pointed out, drinking tea with meals helps inhibit iron absorption from food. Milk products will also help prevent iron from being absorbed.

Do not be concerned if she requires regular transfusions during the pregnancy, as this is normal and even some thal minors will require transfusions when pregnant.

If you have any other questions in mind,please feel free to ask .

Zaini.

Thank you Zaini, SF and Andy.
Actually I am totally new in this forum and I was unable to find my previous post. this is why I have post it again.
I must say I am fortunate enough to find you.
One more thing, some where I have read about Water melon can any one please explain it again if possible.

Hi! Everyone.......

Yesterday we found her (Mou) Hb 7.6. I would like to know the ref. value for her (Thal in pregnancy) in this stage.
Andy you asked for a list of fruit & Vegetable. Here you are:
Banana,
Mango
Apple
Watermelon
Grape (Green/Yellow)
Papaya
Lichi
Black Berry
Pineapple
Pumpkin
Green Papaya
Carrot
Tomato
Potato

Thanks & Regards

Hello Shahed,

I don't know if there is any refrence range of hb for thals in pregnancy but i personally think it may be low,thal intermedias normally do maintain hb of 7 to 8 but in pregnancy i think its low,Please wait for what Andy has to day about it.

All the vegetables and fruits you mentioned contain very very small amount of iron,on the other hand the antioxidant properties and vitamins and trace elements they offer are awesome,so i don't think your wife need to avoid any of them,and you need to learn the distinction between heme and non heme iron,iron in red meat is heme iron which is more easily absorbed in the body,so it can add to iron overload,but iron in veggies and fruits in non heme iron ,which is not that easily absorbed in body,so its not that harmful.

One more thing is when body is constantly on low hb ,it tends to absorb more iron from the gut,tea can help avoid that,please give your wife tea after every meal,that will help avoid absorbing iron from food.

I hope this helps.

Zaini.

Shahed,

When I was transfused, in my second pregnancy, the docs were in disagreement about whether I should be transfused or not.  My hg at the time was 80.  My obstetrician felt that my body would compensate and that the fetus would get enough nutrients and oxygen despite my low hg, a hematologist I was seeing at the time felt that (because I also had placenta previa in that pregnancy and was at risk of bleeding during delivery). 

I think that getting a transfusion at this time may be helpful in terms of boosting your wife's energy and sense of well being, I think it is probably good for the baby as well - but I don't think that your baby is at risk with this hg.  I hope that makes sense. 

Please keep us posted.  As Zaini has said, unless otherwise indicated, most fruits and vegetables do not contain heme iron - therefore a lot of iron will not be absorbed from them.   In fact, you wife and the baby require nutrients from fruits and vegetables. 

Sharmin

This link will help you find what are the exact composition of any food you want to know. It is so helpful.
http://www.nal.usda.gov/fnic/foodcomp/search/

You just write what you want to know and press submit and it will tell you all the details

manal

Hi ALL ,
its very easy to use all that data on your Pc, instead of connecting PC and searching on that site , so from here you can download their Nutrient Data Software to use from your Pc .. after instlaing this software you will be able to check food compostion on your desktop . and it will become easy ...  here's the link ...
http://www.nal.usda.gov/fnic/foodcomp/srch/pcs20.exe

Best Regards
Take Care
Umair

Hi Friends,

I was in my weekend so I cannot post any. Thanks a lot Zaini, Sharmin, Manal and nice friend for your supports. stay close.

BR,
Shahed

Hellow everyone :-) now she got some new problem, her BP is raised to 180-160/100-110 For last 2 days. Doc have her
Nidipine SR-20(nifedipine BP) and MEG-3 (omega-3,EPA,DHA) 1+0+1 Schedule and Sardopa (methyldopa 250) 1+1+1. Is there any suggestion 4m u.