Is This Thal?

I had a blood test done recently and the abnormal results are as follows:

HB 71 (115-160g/l)
HCT 0.24 (0.35-0.47 L/L)
MCV 56 (80-100 fL)
PLT 429 (150-400 X10*9/L)
Polychromasia +2
Microcytosis +3
Hypochromasia +3
Elliptocytes +2
Phosphate 0.7 (0.8-1.5mmol/L)
Calcium 2.09 (2.10-2.60mmol/L)
Albium 32 (35-50g/L)

RBC and WBC counts were normal.

I had to have a blood transfusion of 2 units after the test due to the low hemobglobin and was told that this could be thalasemia. I am seeing a specialist soon but I'm worried. A blood test done a week after the transfusion shows my hemoglobin has come up to 92 but is still low.

A blood test from 10 months ago shows that I had high rbc, low mcv and hemoglobin was 1 point away from being low. Tests from when I was a teenager shows normal rbc but low hemoglobin which my doctors always took as iron deficency anemia.

 I eat healthy, get enough vitamins but have always been on the tired side since a traumatic brain injury 18 months ago. My body went through a huge change afterwards, and my blood tests started to show even lower results. Could a trauma make thal worse? Or if it is thal, can it get progessively worse?

Hi jeevie,

The test looks like thal minor, but a hemoglobin electrophoresis test is required to confirm that. If there was significant blood loss with the brain trauma, including internal bleeding, it could greatly exacerbate the thal minor, and because minors have low Hb to begin with and not a fully efficient hemoglobin producing system, it also takes longer for a minor to recover after blood loss. Thals do often experience more symptoms as they age, but the onset wouldn't happen this quickly. It could also be iron deficiency, and this can also be confirmed with a group of tests called an iron panel. Neither condition is something to get too worried about, but further testing will be the only way to get answers.

Thanks Andy.

I did get my iron tested too and iron is at 1 and ferritin is at 2. I have always had low iron , and no matter the amount of iron pills I have been prescribed, I have not been able to get my levels normal. This is the worst they have ever been though. I am of southeast asian descent, and other health conditions I have seen family members have seem to mimic a lot of the symptoms of thal but nobody has ever been tested as they were never even aware of it until I told them what thalassemia is recently. There is unexplained heart failure and osteoporosis in my dad's side of the family, which seem to be possible with thal.

I had a closed head injury, so there was no blood loss. I think maybe I am feeling the effects of low hemoglobin because I have a very physical job so I get tired out quickly. I have also been paying more attention to my health recently too.

You need further testing. A hemoglobin electrophoresis test can determine if you have beta thal minor. It is quite possible that you have alpha thal minor, as the blood indices are similar to beta minor. An electrophoresis will be able to diagnose beta but not alpha. I bring this up because we are seeing a large amount of reports from alpha thals diagnosed with iron deficiency who do not respond to iron supplements. Many medications can cause hemolysis in alpha thals, so your drop in Hb could be related to medications you were on after the head trauma. Even certain antibiotics and painkillers can cause hemolysis in alpha thal. I would suggest no iron unless an iron panel shows that you are definitely deficient.

I had another blood test done. My iron levels are coming up, my rbc is normal but my hb, hct, and mcv continue to be the same (within a few points over 3 blood tests but still low). Two different doctors think that it is thal and iron deficiency together but they said they can't test me until my iron is back to normal or the results might come back false positive. (I am finally responding to a different type of iron product and I am going for iron ivs). I encouraged my parents to get tested so I am waiting for their test results.

I think what happened was when I went back to work, I was exposed to benzene which would account for such a sudden drop in my iron levels. Now that it is going back up, my doctors should have a clearer picture of what is going on.

Chemical exposure does cause hemolysis in alpha thals and I have had reports confirming this from some beta thals, also, so it may be the reason for the very low Hb level. If you are indeed a thal minor, then you cannot expect to see the MCV and MCH rise. Your low Hb is most likely a combination of thal and iron deficiency, so you may see some increase in Hb, but because of the thal minor, you probably won't reach a normal level.

Thanks Andy! You are a wealth of information My Hb levels have come up but are still low. I have had 3 iron infusions over a 10 day period. I canceled the 4th one as the 3rd infusion really made me sick and I feel like I am getting iron overload at this point. It is hard getting my specialist to order me the hemoglobin electrophoresis test (Canadian Health Care System can be slow on things), and I refuse to be a guinea pig to see how many iron infusions I can tolerate before my systems shut down and I finally get a proper diagnosis and tests.  I have taken all of my test results to an aryuvedic doctor who treats patients with Thalasemia to get them "balanced" as much as possible. (Sorry, I don't know if that makes much sense to others). I am finding his medications are more helpful with the side effects (heart palps, pain, etc) and I am finally able to do more again. My systems definitely do not feel over used and over stressed anymore.

In my research I read that babies with thal can be born with fluid build up but there was not a lot of information.  I was wondering if this is true? This happened when I was born and I almost did not survive.

I finally got the tests and was diagnosed with alpha thal