I'm from Cambodia, please give me some advice, thanks.

I am a 24 female, i used to be healthy, but since 09/2011 , i've started to diarrhoea about a week, then my blood count was Hb 6.5. The doctor just asked me if i have ever had blood tranfusion , i just said no and wondering why they asked that, the just give me some iron pill and some medicine to cured the diarrhoea . Since then i started to have other symptoms : tiredness , shortness of breath , headache , abdominal pain, heart  palpitations, mood change ,pale  and sometimes diarrhoea. i have small bruise  and red dots on the leg.  In 06/2012 i went to another doctor to have my blood test.My spleen 150mm
   
  06/2012                    07/2012                            10/2012                              11/2012                   
RBC  3.94                   RBC  3.94                          RBC  3.70                             RBC  3.99
HB    7.38                   HB   7.54                          HB    7.35                             HB   7.33
HCT   23.0                  HCT  23.0                         HCT  22.1                             HCT 24.0
MCV  58.3                   MCV  58.4                        MCV   59.8                            MCV  60.2
MCH  18..7                  MCH  19.1                        MCH    19.8                           MCH  18.4
MCHC 32.1                  MCHC 32.7                        MCHC  33.2                          MCHC  30.5
RDW  19.0                  RDW 20.5                         RDW   17.9                            RDw  18.0
PLT   250                    PLT 264                           PLT     213                            PLT 227
MPV  7.15                   MPV  6.31                         MPV   6.39                            MPV 7.21
Ferritin 87.6                        142.9                            127.6
                                                       The doctor gave me :
B12 , Folic acid             B9, B12 , iron                     Liveril                                   B12 , vitamin C 1000mg, zince     
( 1 month)                   ( 3 months)                      (1 month)                                 ( 2 months)

1,  Does the blood test show that i have Thalasemia ?  If have , is it Thalassemia Intermedia?
2,  Do i have to do other blood test like: hemoglobin electrophoresis?
3,  My Hb aroud 7 , does it good or bad?  i still have the symptoms like i write about
4. Do the Thalassemia patient have sometimes diarrhoea?

I'm looking forward to your advice, thanks

Hi Hana,

Your Hb level does fall into the intermedia range. Your MCV, MCH and RDW all also look like thal. There is nothing in your reports that suggests iron deficiency, and iron was not indicated when you were prescribed the supplement, as your ferritin was 142 which is nowhere in the range of iron deficiency. Iron should not be taken, as it will eventually build to harmful levels if continued, and also create digestive issues.
Yes, you should have the hemoglobin electrophoresis test done. I cannot tell from these reports if it is alpha or beta thal.
The low Hb is not so good. You should always be taking folic acid. At least 1 mg and preferably 2-5 mg daily.
Your spleen is enlarged, which is expected in thal intermedia and is commonly accompanied by an increased bilirubin level. If you have any yellowing of skin or eyes, this would be confirmed. Diarrhea may be related to the excess bilirubin. Have the red spots improved at all since you've been taking vitamin C?

Hi Andy,

I don't have yelllowing of the skin or eyes, and since i've started taking Vitamin C , the red spots haven't improved , it still the same. By the way i have other questions :

1, About this month, I've just had Upper Left Abdominal Pain ( about 5 to 7 minute a times) , is it due to the enlarged spleen or other reason?
2, I like drinking Ice tea, i've been drinking tea for 10 years, 3 to 4 cups a day. My parents tell me to stop drinking tea, they said that because of i drink too much tea that my Hb level is low or not up even if i take the supplement. Do drinking tea reduce the absorption of vitamins like B12, folic acid , other vitamins, or is it just reduce Iron absorption ? Should i stop drinking tea or not?

Thanks

Tea is an extremely healthy beverage. Do not stop drinking it. It is loaded with antioxidants,which are essential for thalassemics. Tea also inhibits the negative actions of iron in the cells. You have been given iron even though your ferritin level was normal, and your ferritin increased even more. There is a great danger in giving iron to thal intermedia patients because their bodies will already be absorbing excess iron from their diet. Again, this is reason to do the electrophoresis test.

I asked about the vitamin C to see if the red spots are due to breakdown of blood vessels, as in many cases this will be corrected by taking vitamin C. The doctor asked if you have had blood transfusion because if you had, there would be a possibility that you are having an antibody reaction that caused the little red spots. This is called Idiopathic thrombocytopenic purpura (ITP). It can be caused by various other things like viral illness, but the platelet level would be under 100, and yours lies in the normal range. The spots may be Petechiae, which are small red spots that occur due to bleeding from capillaries. You can see the many causes of this at http://www.mayoclinic.com/health/petechiae/MY01104/DSECTION=causes
If you click on the multimedia tab at the top of that page, you can also see a pic of the condition.

Your next step should be the electrophoresis test. You need to know if this is thal intermedia. If alpha thal is involved, it makes it even more likely that the red dots are a result of exposure to some medicine or chemical (and even some foods).

Hi Andy

Sorry for taking a long time , i have just had my Hb Electrophoresis done. The result is :
 
HbA fraction (81.2%)
HbA2 fraction (1.2%)
HbH inclusions : Positive (+++)
HbH fraction (10.2%)

so what does the result mean? what type of Thalassemia do i have? Thanks..

Any HbH level recorded in an adult indicates HbH disease, or 3 gene affected alpha thalassemia. Your low Hb is caused by alpha thal and is not related to iron deficiency. Your ferritin level is strong and iron supplements should not be ingested. Folic acid is the primary treatment for this condition. If Hb level drops below 7 during illness, transfusion may be required, but transfusions would not be a regular occurrence. You should follow a nutritious diet, avoiding empty calories, and you should avoid chemical fumes and certain drugs. A list of what to avoid can be seen at http://www.thalassemiapatientsandfriends.com/index.php/topic,3410.msg34830.html#msg34830