Thal Minor in Elderly - How to deal with low Hemoglobin levels?

Hi,
I'm a newbie but have been hanging around/reading a lot over the last few months. I'm a mom of three young kids all Thal minor (confirmed with electropheris), my husband is the trait carrier, as is his Father (Chinese decent). My question is regarding my Thal minor elderly father-in-law who is in Peru. He is 85 and has been healthy his entire life, with a Hb level around 9.5. The last six months he has had a lot of problems and his Hb levels have  dropped. Since January he's had two rounds of transfusions because his Hb levels were 7. They helped  to raise the Hb level but left him with a continuous headache. They ran a bunch of tests for cancer because his platelets were also very low, but everything came back negative. Today we got a call that his levels had dropped to 4.8 and they are giving him 4 pints of blood. His last transfusion was at the end of April. We are concerned that the doctors there do not know how to handle his condition. We're also concerned about iron overload. What is the lowest level of Hb that would be considered "safe" in a Thal minor elderly man? Other than transfusions and the regular advice of folic acid, vitamins, etc, is there anything else that could help to keep his Hb levels up?

I may be wrong, but thal minor should not cause such a drastic drop in hg.  Perhaps, he is losing blood from somewhere in his body (the gut maybe?).  Has he been checked for occult blood?

Wishing your father-in-law all the best,

Sharmin

Hi mamaofthree,

I think your father should be investigated for bone marrow failure. The cause of the continued anemia needs to be determined and it appears that either his bone marrow is failing or that he has acquired an antibody reaction from transfusions that is rapidly destroying his red blood cells. Has he been seen by a hematologist? One possible cause of sudden anemia is parvovirus 19 which is a common virus that is found in 90% of the population by the time they are elderly, and can cause bone marrow failure. Do you have any information about what type of testing he has laready had? Anything about the characteristics of his blood or other readings like his white blood cell counts?

I'm asking my sister-in-law to send me the blood tests results. He has seen a hematologist but considering the multiple "scratching their head" moments and the fact that the hemotologist is nearly 70 and trained many years ago in Peru, we're not so sure he's up to speed. 

What type of tests would need to be done to determine bone marrow failure? If it was something like the Parovirus 19 (fifths disease, correct?) how long would take to run its course or is it something that causes long-term problems?

Hi mamaofthree,

Here is some basic info about fifth's disease or Parvovirus B19.

http://www.cdc.gov/ncidod/dvrd/revb/respiratory/parvo_b19.htm

Zaini.

About how to detect bone marrow failure ,

From http://www.childrenshospital.org/clinicalservices/Site1970/mainpageS1970P7.html

  Bone marrow failure can usually be diagnosed through a comprehensive medical history, medical exam, blood tests, and a bone marrow aspirate/biopsy (using a needle to remove bone marrow cells for testing)       

Hope this helps.

Zaini.

HI mamaofthree,

A bone marrow aspiration may be required if a reason for the rapidly occurring anemia cannot be found. A clue that it could be parvovrius B19 would be found in the reticulocyte count, which is part of a complete blood count (CBC) which your father-in-law should have had by now.

A discussion of chronic bone marrow failure can be found at http://stemcells.alphamedpress.org/cgi/reprint/14/2/151.pdf

Parvovirus B19 should be considered as part
of the differential diagnosis in any patient with
persistent anemia and low or absent reticulocytes

If his retic count is low, this should be considered. If you do have the results of a CBC, it could shed some light on this. Before the discussion of other possibilities proceeds, it is recommended that the possibility of infection from parvovirus B19 be either ruled in or out, especially when considering the case of an elderly person where intrusive testing would want to be avoided if possible.

Hi, I am 70 yrs. old and have thal min. I have had  about three or four years where it really lowered my hemoglobin. My hematologist told me it has to be up around 18, and mine dropped down to 6.4, so I have weekly iron infusions and was getting a procrit shot once in a while. Now it is just the iron infusions with zantac and benadryl added to them. I really can't complain. I feel much better than I used to even though the exhaustion is still there. Does anybody know what thal min does to the immune system? Should I be doing something else to protect myself with the H1N1 flu season coming up?

GingerV

Hi Ginger,

 

One thing i'd want to warn you about is iron,did your doctor do iron studies on you,or did he just assumed that you need iron because you have low hb,iron deficiency can co-exist with thal minor,but you have to confirm this before taking iron,because excess iron can be harmful.

You should be on folic acid daily and B vitamins for your tiredness,have you checked your Vitamin D levels,Vitamin D deficiency can greatly contribute to tiredness.

Zaini.

Hi,

Yes, I go once a week for the iron infusions and when the level of my hemoglobin comes up past 11.4 she stops the infusions. Then she has me wait four weeks and does the iron blood test. Thanks so much for your advice about the folic acid and vitamins B & D. One of my friends suggested I take bee pollen in the form of royal jelly for my tiredness. Is that about the same? I will check into your suggestions and get some at the drugstore. Thanks so much!

GingerV