Regular blood work for thal minor pregnancies

Hello everyone,

My wife is thal minor and is in her 25th week of pregnancy. I've read several posts on this awesome site on regular blood work and diets. I'm a little worried that her doctor is not that much aware of thal minors and associated pregnancies.  I've couple of questions before I approach the doctor and discuss it:

1) what kind of blood work should be regularly done :
  - Hemoglobin
  - Iron (which specific iron test?)
  - hematocrit  (is this same as Hemoglobin ?)
  - B12
  - anything else ?

2) how often should this blood work be done ? every 2 weeks ? every 4 weeks?
    If the levels were to go low, will there be symptoms ?

3) She has been taking prenatal vitamins from the very first week of pregnancy. The ingredients of her prenatal vitamin is listed here:
  https://www.prenate.com/prenate/PDFs/PRENATE_DHA_PI.pdf

  Does this look like a good supplement ? Any need for any further Folic Acid ?

  She has been eating a lot of fruits, vegetables and protein along with this supplement.

Thanks so much.
Sumit
 

   





   

Could someone please comment on some of  my questions ? Our doctor appointment is this week.

We want to educate my wife's Gynecologist on some thal minor related issues.

I've read some of Andy's supplement recommendations, and I'm going to ask for an increase in folic acid for my wife from 1mg to 5mg. I'm also going to educate her on possible cases of transfusions during labor.

Thanks a lot.

I've never been pregnant, but will try to answer.

Either the hematocrit or Hb are used. They are simply different methods to check the Hb. This will also be used to help determine if iron should be taken. It usually is prescribed whether women need it or not. Blood sugar will also be checked. The tests and checkups will be the same as for any pregnant woman. Hb level normally drops during pregnancy, so don't be alarmed. This is somewhat due to a dilution effect caused by the weight gain and the fact that the fetus also requires the attention of the mother's body. If the Hb drops to 8, transfusions may be considered. However, if it is stable at this level, transfusion should be based on the physical condition of the mother. If she is coping fine, then transfusion should not be pushed. If the mom feels overtired, she should also have her vitamin D level checked.

The vitamin is OK, but I would definitely add 400 IU natural vitamin E daily and raise the folic acid. There is no real need to get doctor's approval for vitamins. The exception is vitamin E should not be used when one is taking blood thinners. This is unlikely during pregnancies.

Thanks Andy.

My wife's blood report came back. Hb dropped to 9.8 (27th week). It used to be around 11.5 before pregnancy and 11.4 at 17th week.  Here are the other counts:
   
   Iron Bind Cap (TIBC)  -  371 (250-450)
   UIBC - 272  (150-375)
   Iron, Serum - 99 (35-155)
   Iron Saturation - 27 (15-55)
   Vitamin B12 - 277 (211 - 946)
   Folate (Folic Acid), Serum  -  >19.9  (>3.0)
   Vitamin D - 33 (32-100)
   RBC - 4.46  (3.8 - 5.1)
   Hematocrit  33.4 (34 - 44)

Since the Iron is looking good, the doctor is not prescribing iron supplements.

The doctor said nothing to worry about if she is not feeling weak, dizzy or any shortness of breadth. My wife is feeling OK most of the time, except some days (1-2 days every 10 days she is a bit weak. maybe that is just due to pregnancy and nothing of concern)

She is getting 1mg of folic acid from her prenatals. We were considering increasing that to 2mg. Would that be ok even though her folate, serum is >19.9 ?

One more thing - her RBC used to be around 5.2 at 17th week, that has dropped to 4.46. the doctor didn't say anything about that.

thanks a lot.

Her folate level is great, so there is no reason to raise her intake. The RBC change is well within range and not significant. Her Hb is still strong for this late in the pregnancy. Iron levels are all good. I see no reason to change a thing at this point. All looks good.

Thanks Andy.

One more question - is there a test to check Vitamin E levels ? She has been taking prenatal supplements which has only 10 IU. I've seen several posts which suggest taking 400-500 IU because it has mind blood thinning capability. based on the cases, does lack of Vitamin E cause trouble in early or late pregnancy ? thanks!

There is a test for vitamin E, but it isn't relevant in the discussion of pregnancy in thals. The point of vitamin E is its antioxidant properties and its blood thinning capability. To ensure these effects, a constant and regular supply is required. You cannot get enough of this through diet.
From the reports I have read here, I have to say that this is a problem that can exist throughout the entire pregnancy, as a reduced blood supply between uterus and placenta leads to slow fetal growth and in many cases, eventual miscarriage. If fetal growth has been normal and the mother's health is good, there is much less chance of problems existing.