Thal minor and pregnancy

Hello All,

Joined the forum just yesterday, am 29, Indian and 5th month in the pregnancy. Last week checked my hemoglobin it came 7.5, though I have never been more than 9 as far as I can remember but 7.5 is the lowest ever for me. My Gyne has referred me to a hematologist who insisted on getting all the tests done again as he wasn't comfortable taking action based on the earlier reports.  Have gone through many threads here since I am not feeling too week transfusion has not been discussed so far and moreover what I have gathered in India they generally don’t transfuse below 6. Here are the some other tests values:

Hb – 7.5
RBC 3.31 Mil/Ul reference range (3.8 – 5.8)
ESR 90 – on higher side reference range (1-20)
Iron Binding Capacity 338 ug/dl reference range (250-425)

I am trying to take the rich iron diet, have been prescribed iron, Folic acid, calcium and thyroxin sodium tablets (was diagnosed mild thyroid problem). I am concerned since I have a low lying placenta as well (grade1) I have the next appointment with the hematologist next week. Hematologist did insist in not recommending iron without seeing the test results am continuing so far since it was prescribed by the gyne.

Please suggest and also let me know if I need to ask some specific questions to my hematologist next week.

Thanks

Suhani,

Do you know if you are Alpha Thal (Minor) or Beta Thal (Minor)? You hematologist might be trying to confirm for sure what the real picture is rather than make assumptions depending on your previous report.

From what I have read, when pregnant the body needs higher HB levels. Taking transfusion when pregnant would help you and your child so please don't feel scared if you have to take few transfusions.

Look at the following thread - http://www.thalassemiapatientsandfriends.com/index.php/topic,3041.0.html
It has a link to many thal minor pregnancy posts our members have written.

Hi Suhani,

Do you also have results for serum iron and ferritin? The TIBC is normal and wouldn't indicate that there is iron deficiency. The hematologist is wise to wait to see results before prescribing iron for thal minors. But if your other numbers are low, you may need iron while pregnant. You might want to ask the hematologist about the low RBC count, which is normally high in thal minor. If iron deficiency does co-exist with thal minor, that might explain it, but it's best to know before taking unneeded iron supplements. An iron rich diet is fine during pregnancy but supplements beyond that should only be taken when deficiency is confirmed. I would also suggest taking natural vitamin E as it has many good properties as an antioxidant but is also a mild blood thinner, which is important in thal pregnancies. You should also ask your Gyne if a daily aspirin would be appropriate during the pregnancy. We hear many reports of issues related to clotting in the placenta and some doctors will prescribe a baby aspirin daily. I too, would recommend watching the Hb closely. It shouldn't be allowed to drop further during the pregnancy.

Thank you Narendra, Andy for your time.

Sorry but have been ignorant so far and never bothered regarding the type so never got it confirmed, but the tests which have been prescribed now would give the type along with iron levels.

Hello Andy,

I quickly went through the major sources of vitamin E, and looks like some of the things which I have increased the intake for iron, Spinach and almonds would help for Vitamin E as well. Anything particular which you would suggest for a vegetarian. I would keep in mind to discuss the points you have raised with my gyne on the next visit.

However one question, I have been going through the threads suggested by Narendra but couldn't find details apart from weakness would a low HB have any major effect on the fetus?  Honestly since I am not feeling too weak as of now (touch wood) should i still go for transfusion for some other reasons?

Thanks

Andy, the reports have come and here are the results, posting everything i got in the report just in case if it helps:

Haemoglobin Chromatography

Hba 92.2%  (Range 95-98%)
Hbf 1.2%    (Range 0-1%)
HbA2 5.2% (Range 2.2-3.5%)

Haemoglobin Indices

Hb 8.0 (Range 11.5-16.5%)  - It's marginally higher than my last reports(from 7.5), not sure of the reason may be because of diff lab as sample was taken 1 week after the last one, or it really improved.
RBC 3.65 (Range 3.8-5.8)
MCV 66.6  (Range 76-96)
MCH 21.9  (Range 27-32)
RDW % 18.3  (Range 11.5-14.5%)

RBC Morphology Beta Thal Minor
Ferritin 55.5  (Range 11-306)
LDH - 140 (Range 81-234)

I knew my husband is not a thal minor but Doctor had run the test again and it confirmed he is not a thal. Finally Hematologist said you can continue the iron in pregnancy but has suggested to go for transfusion to bring the Hb to 10. I did say throughout my life i have never been above 9, he said still i would prefer the transfusion. Am nervous about the transfusion and i wwould rather increase it naturally if possible.

Thanks

Hi suhani
You will be able to increase your hb naturally just by taking one glass of fresh pomegranate juice daily. This has always worked for us (sisters and cousins). As a thal minor my hb usually hovers between 9 - 10, but during pregnancy it usually is a healthy 11, as that's the only time I actually care for my health. Try it for 2 weeks atleast and of course your doctor knows the best.

Suhani,

As long as you are not tired and fatigued, you probably don't need a transfusion. You can decline it, but please do watch how you feel and if you become excessively tired for a period of time, a transfusion might be considered.