3rd trimester Thal A minor and low iron

Hi all

I read a lot of posts on Thal minor but are they generally Beta Minor? I am disgnosed with Alpha Minor and is currently 28 weeks pregnant. I had a stillbirth at 36 weeks 2 years ago followed by a miscarriage last year. I am very concerned about the effect of my thal condition and low iron which may cause history to repeat itself. I understand that I have to monitor my HB levels looking at all the previous posts and I just did my iron test waiting for results. Any advice from anyone would be assuring and much appreciated. FYI the stillborn had a chromosone disorder and a related heart abnormality but we don't know what happened at 36 weeks. All I can remember was that I felt extremely tired that morning and by night there's no movement. Could this be related to my thal condition or low HB? How can I prevent low HB? Wouldn't it be too late to wait for blood test results every month? And when you talk about extreme fatigue, how do we know how "tired" we are to be of concerned? I get tired easily but usually a nap fixes it so it's that normal? Thank you all in advance for your advice!

Hi joenbby,

Has the father been tested for alpha thal? Only a DNA analysis can be totally definitive with alpha thal, and because of the stillborn, this information is critical to make sure the stillborn was not alpha major, as alpha major is not compatible with life, because no hemoglobin is produced, and the fetus dies by birth.

Miscarriage seems to be common in both alpha and beta minor, based on the numerous reports we receive here. Folic acid is very important during pregnancy and thal minors need higher doses. 2-5 mg daily is recommended. Alpha thals should take folic acid regularly anyway, as it is essential for building red blood cells. The other supplement that can be very important to thal minors is natural vitamin E complex. 400 IU natural E daily is suggested. This can help to prevent a common clotting issue that is found in thals, which causes a reduction in blood flow from the uterus to the placenta and sometimes partial detachment of the placenta. Vitamin E acts as a mild blood thinner and also as a powerful antioxidant, both properties being key to preventing the conditions that can lead to blood clotting in thal minors.

Hb should be monitored during the pregnancy. Some minors do require a transfusion or two during pregnancy, when the Hb drops below 8.

Thanks Andy for your reply. Father has been cleared of thalassemia. I'm currently taking a multivit for pregnancy which has folic acid 500ug and 10.4 IU vitamin E. Is that sufficient? I've also just started taking iron tablet with Vitamin C.
I will let my gynae know that I would like my hb monitored. Is there any way of monitoring hb with instant results as in I do not have to wait till the blood test results for a few days. I just feel that it's too late that way. Is monthly blood test for hb sufficient to prevent any mishaps?
What other things should I look out for or monitor? Thanks.

Is it necessary for me to see a hematologist?

Welcome to thalpal.

You should read the thal (minor) pregnancy posts that are at http://www.thalassemiapatientsandfriends.com/index.php/topic,3041.0.html

There is no need to see a hematologist unless your Hb drops quite a bit. I also think that monthly blood tests will suffice unless your Hb drops below 9. At that point, more frequent testing would be required to monitor the situation, as occasionally transfusions are needed during thal minor pregnancies. There are methods of doing the hemoglobin test that give results within one minute.

Thanks Andy.

My blood test results just came back. HB level 11 and Ferritin 7. I'm on iron supplement with Vit C now. Not sure what else I can do except to request monitoring HB level and hopefully my iron stores will increase as we go along.

With an Hb of 11 in the third trimester, there seems little likelihood that a transfusion would be required at any time during your pregnancy.

We see many reports of low ferritin in alpha thals whose other iron numbers are fine. I doubt that the ferritin levels are accurately reflecting the true iron level. The serum iron level and TIBC would be more relevant. With your Hb level at 11, it is doubtful that you have iron deficiency, but I don't see any harm in continuing the supplement during the pregnancy, as the baby does raise the iron requirements.