Please advise - is warmer climate more suitable for Thal Minor to live?

Hi everyone,

I would like to ask if warm climate help in minimising the symptoms of Thal Minor. We live in Beijing where the winter is very long, very cold and dry. He also has asthma.  So is it better for my son to live in a place with warm and humid weather, which will help his blood circulation and consequently increase his energy level?

Looking forward to any advice. Many thanks.

Hi Leung,

I personally prefer colder weather. I live in the southern U.S and it get very hot and humid in the summer. Just going outside drains my energy and i find it hard to breathe. As a kid I played in the heat alot and I still live here, so I guess the answer is while I prefer the cooler weather I still survive the heat every year. I don't have asthma, so I'm not sure how the heat affects it.

I share Bobby's preference on the weather. I do not have asthma, but I seem to be more comfortable being cooler than I do feeling hotter. Our 15 mo old that we believe has Beta-Thal minor wilts in the heat rather quickly, he will run around for a few minutes and then will just sit in the grass and wait for us to pick him up, his face turns bright red, and he is totally zapped of all energy (it usually takes him at least 24 hours before he perks back up again), and this is a well hydrated boy.

We also live in a humid and seasonally hot area in the U.S. and I can't say the weather is to blame (there are many environmental factors here), but the rate of asthma and severe asthma is very high here!

Best wishes.

It is believed that the hemolysis that is present in all forms of thalassemia generates heat as the red blood cells break down. As a result, thals are typically hot, not all but in my experience, most.

Many thanks for all the sharing to my post so far.  Really appreciated.

I have gotten a CBC result for my son as shown below.  Still awaiting for the Iron panel test and the Vit D test.  Frankly speaking,  Thal minor is not common in Northern China, so doctor here is not familiar with this. My husband seems like a normal person, he does not show sign of fatigue or tiredness, why my son is so tired all the time? Is it because he has too many activities?  He is 40kg at age of 12.  What can I do to help to increase his appetise and also his energy level. He looks tired all the time. But he is active in sports, should I reduce his activities?  His school work is also demanding (but he enjoys his school though not his homework), and he needs to do homework until 11pm at night.  His lack of concentration and slowness makes thing even worse for him. He probably cannot concentrate well in class too, I guess.  I am thinking of changing school for him, should I?  What can I do to improve the situation?   My husband is Alpha thal minor carrier.

CBC Results below:
 
CBC with Auto Differential (result, units, ref range)
- WBC = 8.4, x10^9/L, (3.5 - 10.5)
- Hgb = 112 L, g/L, (128-160)
- HCT = 0.359 L, L/L, (0.373-0.473)
- MCV = 65 L, fL, (81-92)
- PLT = 293, x10^9/L, (100-400)
 
- NE% = 0.652, Retio, (0.500-0.700)
- LY% = 0.317, Ratio, (0.200-0.400)
- MO% = 0.031, Ratio, (0.020-0.100)
- NE# = 5.5, x10^9/L, (1.4-7.0)
- LY# = 2.7, x10^9/L, (0.7-4.5)
- MO# = 0.3, x10^9/L, (0.1-0.8)
- RBC = 5.51 H, x10^12/L, (4.40-5.50)
- MCH = 20.4 L, pg, (26.0-34.0)
- MCHC = 312 L, g/L, (315-365)
- RDW = 16.2 H, %, (11.0-15.0)
- MPV = 8.3, fL, (6.0-11.0)
 
Microscope:
- Neutrophil = 63, %, (40-70)
- Band = 1, %, (0-5)
- Lymphocyte = 34, %, (20-45)
- Monocyte = 2, %, (2-10)
- Eosinophil = 0, %, (0-5)
- Basophil = 0, %, (0-2)
- Atypical Lymphocyte = 0, %

The only universal recommendation for alpha thal is folic acid. I would suggest he take 1 mg folic acid daily. I would also suggest that whenever possible, he take an afternoon nap after school for 45 minutes to an hour. This definitely helps thal minors recharge and will help him through the rest of the day. Encourage him to eat fresh fruits, especially fruits like berries, as they are high in antioxidants. He should also avoid chemical fumes of all sorts, as they can cause early destruction of red blood cells. He should also learn to pace himself when exercising, so that he doesn't deplete his oxygen stores as quickly.

Hi Andy, is hemolysis present in thal minor too ? Thanks!

Yes, the small red ineffective red blood cells observed in thal minor are eliminated from the body through hemolysis. The higher the rate of ineffective erythropoiesis in the bone marrow, the more hemolysis will take place.

100% in agreement with Andy about the nap.

Sharing another one - my wife (thal minor) can't take hot weather either. She starts developing bad headache and gets tired very quickly in hot weather.

Btw, any experience of thal minor at high altitude ? does thin air cause any symptoms ? I'm considering a trip to Denver and want to make sure my son (8 months old) does OK.

My son does not like afternoon nap.  Even he is tired, he always like to find something to do. Like these few days, he went out for basketball after school.  He just loves sport.  But I find out that he does not feel like eating after exercise. When I observe his peers after swimming training, they are so hungry. Is it because my son over-exercise, so he lose appetite?  How can I improve his appetite as he needs more nutrient?  Andy, apart from the Folic acid 1mg daily, you mentioned to take natural Vitamin E 200IU to 400IU?  How about multi-vitamin or any supplements good for him in view of his poor appetite?  His Ferritin is 46.9ug/L and his Iron is 19.01umol/L.  His TIBC result is not available until next week. These two readings are within the range. So does this mean he is not deficient in his iron level, so does he need multi-vitamin without iron?  

Thanks for sharing experience about Thal minor dislike of heat.  It is quite strange that actually most Thal carriers are present in the southern China where it is more hot and humid,  and South East Aisa which is tropical weather.  Thal is really rare in northern China where weather is cold and dry as far as I understand.   We are thinking of moving back to the south as Beijing is really too cold and dry in winter, as our son, who is a Thal minor, also has asthma. The cold dry together with the air pollution in Beijing really does not do any good to his health, especially now he is stepping into puberty, critical stage of growth.  I just hope south will offer a warmer and humid weather which will improve his asthma and also his health.  This is really a tough decision.

Andy, please advise what appropriate supplements for my son. Thanks.

By the way, my heart feel sour when the doctor said to me and my husband (in front of my son) that my son has both thal minor and asthma, worse on top of worse.  The only way is to cut down his activities.  I feel so bad, I think my husband does, that our son loves sport so much, he is a very good swimmer, and he should cut down his activities.  (though seem like my son does not care about what she said)

Sumit,

Thal minors will have the same problem anyone who lives at low altitude experiences when they travel to a high altitude. Because there is less oxygen in the air, there is less oxygen available to the body. It's important to pace yourself. Longer term stays at high altitude will cause the Hb level to rise, as the body compensates. This begins after about 3 weeks. There is no danger, like there is with sickle cell carriers, who can have a sickling crisis at high altitude.

Leung,

Exercise would not cause him to lose his appetite. I would be more concerned about making sure he is well hydrated when exercising, and that lost minerals are replaced. I don't know what is available there, but a sports drink like Gatorade can be useful for this purpose. Restoring the minerals lost during exercise may help his appetite normalize. Is he more willing to eat smaller portions more often throughout the day? Finding foods he really likes that are also nutritious should be a goal. I would suggest a multivitamin without iron, unless his iron stores get lower.

Asthma does not necessarily have to limit his activities. The asthma should be treated. There are medicines that help prevent exercise induced asthma that can allow normal levels of activity. I have much personal experience with asthma, as both I and several of my children have asthma. My oldest son has had good success with Singulair (Montelukast) so he can play basketball without taking an inhaler first. You should ask the doctor about treatment. Activity is so important to help hi maintain his health and it should continue to be encouraged. Learning good breathing techniques can also help reduce asthma symptoms.

Thank you again for your great advice, Andy.

He uses Flixotide inhaler whenever he has cold or flu symptoms, as sometimes asthma follows after cold.  I feel conscious of using these sort of inhaler as this usually have steriod only unless necessary.  My friend told me Singulair is better option as it does not have steriod content, considering a safe medication for preventing asthma.  So I let him have Singulair whenever he has cough, cold.. to prevent asthma. 

I can only find folic acid 800mcg from GNC web Hong Kong, is that ok?  I am asking my friend to buy this, together with the multi-vit and vitamin E,  for me from Hong Kong.  I want to know if he takes vitamin E, Folic acid 1mg, what should I watch out when selecting the multi-vit apart from no iron?   He has been taking 250mg Vit C, omega 3, and a tab of Caltrade with calcium300mg and D3 60IU daily.