Shortness of Breath along with Uneasiness in abdomen in Thalessemia Trait

I am 29 years old working woman (single). In last February, I suffered from breathlessness. In addition to oxygen inhalation, doctor suggested ECG as my pulse was 120. Except for Sinus Tachycardia, ECG was normal. After few days, pulse became normal (80+).
The results of the subsequent tests were following:
Month     Hb    MCV   MCH   RBCs   RDW   Iron    Ferritin   TIBC
February     9.6   59   17.3   5.55   16         
March                  82   27.6   411
August    8.7               77   <5.0   297
September 9.8   56   17.2   5.7   20   74   43.88   345
September 10.8   57   17.9   6   20.5         
October    10   61   19.1   5.26   19.7         
December    9.3   61   22               

Electrophoresis report (March) showed Hb A as 94.8 and Hb A2 as 5.2 %. Doctor told me that I have 10 % problem of Thalassemia. On his recommendation, I started to take folic acid (5 mg). Later on, when my Ferritin level was dropped to <5.0, I started iron supplement on the recommendation of doctor.

After taking folic acid for some time, I have to stop taking it, as it develops dryness in my mouth and some times allergy (sneezing due to excessive dryness) (I have the problem of allergy for many years). However, I have to start folic acid again after some time due to my health condition. In all, I have taken approximately 150 tablets (5 mg) since last march when my trait was identified.

The problem I faced during this year is Shortness of Breath. At times I am Ok, but at other times, I am in much trouble. During travelling by bus, occasionally my breath is no more comfortable and the most trouble I feel is in the abdominal muscles. In that condition, it becomes difficult for me to walk. And if still I walk, uneasiness increases. Once it happened (in August) that I have to walk in that condition, the result was out of control abdominal pain. The pain vanished after few minutes of taking folic acid. No other medicine was taken by me. After this, a couple of times, again I felt this type of pain and it disappeared few minutes after taking folic acid. When I discuss this uneasiness or pain in abdomen, doctors take it as some problem related to stomach or intestine. But, I feel that this is not the case. I can associate this with two things: walking (or physical exertion) and folic acid.
Some times, I feel this uneasiness in abdomen even in comfortable sitting with out any traveling as right now I am feeling. In laying position I feel better.
Kindly tell me
1.   Which type of Thalassemia trait I have: Alpha or Beta?
2.   What I have to do to avoid dryness cased by folic acid?
3.   Should I continue iron supplements also?
4.   Why I feel uneasiness in abdomen along with Shortness of breath (which if not addressed properly converts into pain)?
5.   Before the last year, I didn’t use folic acid, what happened to me that now I am becoming folic acid dependent? Have my trait activated? What I should expect in my later life regarding my trouble?
I shall be very thankful for you for replying my questions and giving me suggestions.

Hi Aishah,

Your tests indicate beta thal minor. High HbA2, low Hb, low MCV and high RBC count all point to beta thal minor. Folate is not a drug and will not create dependency. However, your body does already depend on folate for survival, so there is an inherent dependency that won't be affected by taking supplements. One of our members, Janco, has mentioned that some people need to take a specific type of folate called methylfolate, as there bodies have trouble using the folic acid typically found in supplements. Talk to your doctor and see if you could try methylfolate to see if it relieves the problems associated with folic acid. I would have to see iron results in addition to ferritin level to comment on whether or not you need iron. Please note that iron supplements are well known for causing stomach discomfort. In most cases, I prefer trying to raise iron levels through diet when needed. Shortness of breath is due to your lower than normal hemoglobin level. Because your Hb is low, there is not sufficient oxygen being delivered throughout your body during activity. You may also note numbness or tingling in the extremities. Folic acid did not activate your trait. It is part of you and nothing will change that. It is a hereditary condition caused by a defective gene that has been with you since conception. Folic acid is a basic nutrient needed to build red blood cells. I am more inclined to believe that you are either allergic to the current type of folic acid you are taking, or have a condition that renders that type of folic acid useless. Talk to your doctor about methylfolate. You might consider trying a B Complex vitamin supplement with B-12. This can also help with anemia by supplying the needed nutrients for building blood.

Also, this is a very active group so there is no need to post the same post more than once. Have confidence that you will receive a reply.

Thanks a lot Andy!

Your reply is of great worth for me. Now I can search beta thalassemia trait to be aware of my problem. Also I will ask now about methyl folate.
Please help me how I can relieve myself from abdominal uneasiness accompanied by SOB.
The reason I posted more than once was that the table was not being displayed properly.
My iron level at three points (March, August and September) was 82, 77, and 74 respectively. Ferritin was 27.6, <0.5 and 43.88 and TIBC was 411, 297 and 345 at these points. The reason of dropping Ferritin may be that I completely stopped iron after my trait was identified according to the recommendation of doctor. In August when I experienced severe abdominal pain, I consulted the doctor and he suggested me these tests again. After taking folic acid along with iron supplement (Sangobion: each tablet contains 250 mg Ferrous Gluconate) regularly, Ferritin rose up to 43.88. Afterwards I took iron off and on.   

Other values
Hb during last year: 9.6, 8.7, 9.8, 10.0 and 9.8 in February, August, September (beginning), September (end), October and December (Range: 8.7 to 10.8) (range during my previous years of life: 6.9 to 11.0)
RBCs: 5.55, 5.7, 6.0, 5.26 and 4.22 in February, September (beginning), September (end), October and December (Range: 4.22 to 6.0)
MCV: 59, 56, 57, 61 and 61 in February, September (beginning), September (end), October and December (Range: 56 to 61)
MCH: 17.3, 17.2, 17.9, 19.1 and 22 in February, September (beginning), September (end), October and December (Range: 17.2 to 22)
RBCs Distribution Width: 16, 20, 20.5 and 19.7 in February, September (beginning), September (end) and October (Range: 16.0 to 20.5)
I read that high RBC Distribution width reflects iron deficiency, is it?

All of your test results for iron are in the normal range except for the one ferritin reading. The only time you showed an iron deficiency in the 3 months was during the time you stopped iron. The RDW is high in both thal minor and iron deficiency (IDA), and high when the two are combined, so this doesn't shed much light on things. 16 would indicate thal minor but would be low for IDA, so the one month hints that your iron level was OK. You do seem to respond to folate, so finding a type that agrees with you would help a lot. If your diet is normal and you get both foods with iron and also foods with vitamin C to help absorb iron, you shouldn't need to take iron for a long period. Ferritin is the least relevant of iron scores because it varies greatly and is affected by even mild infections, like the sniffles. If your serum iron and TIBC stay within normal range, iron shouldn't be needed.