reports and diagnosis

hi.. ANDY    AS PER UR SUGGESTIONS  HAVE STARTED THE DOSES BY BREAKING IT ONE TAB IN THE MORNIN AND ONE IN THE EVE.........AS THIS MARCH HER REPORTS WERE AS FOLLOWS    .kindly suggest
Baby Manit ...Age 9 Yrs.......takes asunra 800mg daily ........requires one unit of blood evry 15 days.....haemoglobin is maintained 10 .....the following are the reports
Serum Creatinine --------0.30   mg/dl
Sgot                  ---------44.0  U/L
SGPT               -----------52.00 U/L
FERRITIN           ----------4457.60   ng/ml


IRON OVERLOADING

HEART          16.43      mild
LIVER            1.40       MODERATE TO SEVERE


EXAMINATION DEXA, SPINE, HIP,Lt FOREARM

T SCORE    00
Z SCORE     -0.2


THANK YOU

The iron loading definitely needs strict attention. What is the child's current weight?

Hi andy
 my daughters current weight is 21 kgs.....

The current dose of Asunra is appropriate for the iron load of the child. Her kidney and liver values are all in range and these should be regularly monitored. Give the drug some time to work but you should see progress over the next 6 months with this dose.

  thank you andy....yea tht is wat evn i thought aftr seeing the reports as u had told me earlier tht this med takes time ....will do the tests again aftr 6 mnths tht is in september.....well andy i have also started  vit b complex and folvite on regular basis as she never took those med earlier
     one more quest i had was ....Is splenectomy must for evry thal major after a certain age.....and if no then wld like to know how to avoid it

Hey Andy ,



 Kindly explain this line that u wrote
 Her kidney and liver values are all in range
 u mean is it good or bad .....

Splenectomy is no longer done in thal major or intermedia unless the spleen is dangerously enlarged or is causing hemolysis that cannot be controlled. It is a last resort and in most thals, should never be considered. By "in range" it means that the tests all fall within normal range, so there is no concern.

Thank u so mch andy m relived now.....

Hi Andy,

Could you shed more light on splenectomy? In childhood, I had docs said I had nothing. Its near stomach I believe. How could I spot? And what is hemolysis?

Thank you.

Pratik,

Splenectomy means removal of the spleen.  In previous years thalassemia major patients often had their spleens removed because they became enlarged.  The spleen in thalassemia becomes enlarged when patients are not adequately transfused, when patients are anemic the spleen enlarges and when the spleen is large it causes hemolysis. 

Hemolysis means breakdown of blood cells. The spleen was removed for two reasons, one to reduce the breakdown of blood cells, and secondly because a large spleen can rupture if the patient incurs an injury to the abdomen. 

A normal sized spleen is usually tucked beneath one's ribs on the left side.  As it enlarges the spleen begins to fill the area beneath the ribs and can be felt beneath the left rib cage when the patient breathes.  Sometimes the spleen grows toward the back and can be felt on the far left side of the rib cage.  Doctors often feel for the spleen by GENTLY touch the abdomen beneath the left rib cage or tapping the ribs (a hallow sign indicates a normal sized spleen). 

I do not recommend jabbing your own abdomen, as you do not want to poke yourself in the spleen - it is always best if a doctor feels your belly. 


Pleasance,

you are doing the right thing - splitting the exjade dosage.  You may initially see a rise in ferritin level - that is not a bad thing - it means that the exjade is entering your daughter's organs are removing the iron and releasing it into the plasma (blood stream) resulting in a higher ferritin reading.  It may take up to a year to see really good ferritin levels but you will need to be patient in the mean time.  Soon her iron levels will be well controlled.  Please keep posting any concerns that you have. 

We are all here for you and we will get Manit's iron levels down and get her healthy!   

We have taken Andy's advise religiously and it has benefitted us greatly.  Little A went from an iron level of 2800 to <400 in just over a year. 

 

Sharmin