My 22 month old Grand daughter

Hello,

I have been doing a lot of reading on this site, thank you for the wealth of information!

I was diagnosed as a child as having Thalassemia minor. My daughter who is now 27 also has it.

She took her 22 month old daughter for blood work and testing to see if she is also thal.

Her results are as follows:

                     Result               Flag                                Reference[/b]

WBC              10.9                                                      6.0-18.0 x10*9L
RBC               5.85                 H                                   3.70-5.30 x 10*12/L
HB                 101                  L                                   107-131 g/L
HCT               0.32                 L                                   0.33-0.39 L/L
MCV               55                   L                                    70-86 fL
PLT                499                  H                                   180-440 x 10*9/L
Neutrophils     3.8                                                         2.0-5.5 x 10*9/L
Lymphocytes   5.9                                                         3.6-12.0 x 10*9/L
Monocytes      0.9                                                         0.0-0.9 x 10*9/L
Eosinophils     0.3                                                         <0.5 x 10*9/L
Basophils       <0.1                                                         <0.2 x 10*9/L
Immature Gran <0.1                                                      0.0-0.1 x 10*9/L

MCH                 Pending
Hemoglobin F    Pending
Alk Hb Electro    Pending
Hgbpathy Com   Pending

The pediatrician has told my daughter that her daughter is a beta minor carrier. And that she should be tested when she becomes of child bearing age for Thal alpha. Would they not be able to tell now?

The Doctor also sent an email to my daughter stating that she should be giving her 45 mg of iron and later changed it to 30 mg to be given throughout the day and to eat an iron rich diet. She also said that my daughter should be giving her 2000 iu of vitamin D and a multi vitamin. The baby weighs 10.2 kg or 22 1/2 pounds. She is on the 25th percentile for height and weight.

From my layman's perspective I cannot see any reason for the iron. Would any of you please be so kind to share your thoughts as I am very worried about making a mistake with my grand daughter?

Thank you so much,
Grammie

It's almost certainly thal minor and the electrophoresis will confirm that if the HbA2 % is higher than normal, as it is with beta minor. Alpha thal can be detected at birth. If the child has the newborn electrophoresis at birth, it would have picked up hemoglobin barts if alpha is also present. The presence of alpha thal also would not be a problem, but it seems unlikely if it was noted at birth.

I would advise an iron panel before commencing iron. I will say that the extremely low MCV does make it more likely that her iron stores are also low, but a full iron panel should be done to confirm iron deficiency, if one has not already been done.

Thank you very much for your quick response, it is greatly appreciated.
As I am not a doctor I do not understand all of the blood tests that were taken. Was her iron level not checked? Or her ferritin level?

Thanks again,
Grammie

No, the iron tests aren't shown. This is the complete blood count, and simply put, there are several values, including hemoglobin, which are low. These can all be caused by thal minor, but they look a little lower than normal for just thal minor, so iron deficiency may also be present. If the iron tests have not been done, and they may have been so have your daughter ask the doctor if an iron panel was done. I suspect iron deficiency is likely here and if her hemoglobin level rises once she starts iron, it will show that iron deficiency is at least part of the reason for the low test numbers.

At the bottom of the results you showed, it says pending for Hemoglobin F. Has she gotten the results yet? High HbF will make one suspect thal minor. If they found high HbA2, it is certainly thal minor.

Thank you very much Andy. It has taken a long time to get a copy of the full results.

Test                                                          FLag                             Result                        Reference Range                                                                           


Activated PTT                                             L                                  20                              22-25
Iron                                                           L                                  6                                9-30 umol/L
TIBC                                                          H                                  73                             45-70 umol/L
Ferritin                                                       L                                  8                                12-95 ug/L
Transferrin Saturation                                   L                                  0.08                            0.15-0.55
Alkaline Phosphatase                                   L                                   134                             145-320 U/L
25-Hydroxyvitamin D                                   L                                    49                              75-200 nmol/L


Other tests she had were in "normal range".

Glucose Random, Electrolytes, Urea, Creatinine/eGFR, Calcium, Albumin, Gamma GT, ALT, TSH, Immunoglobulins, Tissue Transglutaminase Ab.

Please let me know your thoughts. The Family doctor at this point has told her to feed the baby an iron rich diet, meat at every meal. And to increase her vitamin d supplements.

Is it harmful for someone with Thal Beta Minor to take iron supplements and will it help with the levels?

Thanks so much again!
Grammie

Sorry, just saw some more results as it is 6 pages long.

Hemoglobin a/Total Hemoglobin          90.6%
Hemoglobin A2/Total Hemoglobin        5.4%
Hemoglobin F/Total Hemoglobin          4.0%
Hemoglobin Investigation
MCH                                      L          17            Normal Range 27-31
Hemoglobin H Inclusion Bodies            Negative
INR                                                   Normal Result

Yes, the iron tests confirm that iron deficiency is also present. The lower than normal for thal minor MCV did suggest that iron deficiency is also present. The MCV may rise as the low iron is corrected, but will not get to normal because of the thal minor, which is confirmed by the electrophoresis. A good diet is important for both thal minor and iron deficiency. Low D is very common in thal and non-thal alike. Raising the level can help with tiredness and improve the immune system. My doctor told me to take it even during the few months I can get sunshine. 2000 IU may be enough to help children. It was too low for me. I had to go to 5000 IU daily to get my D level above 30.