Does my child has IDA or Thal Minor *** PLEASE advise

Greetings All,

To make things short, my son is now about 2 years old. Since birth he was breast fed until he was 12 months. After that he was on cow’s milk, no powder milk or cereal was giving to him and his diet was depending on the milk mainly with little hard food. We discovered he has Low HGB through normal CBC test when he was 9 months old. He did take iron supplement but not for long. His HGB went up a little and then we stopped giving him the Iron Supplement regularly due to some problems the supplement caused. Until he turned 20 months old we did another test and found out his HGB is still low 10.7. From Jan 5th, 2013 until yesterday he is taking iron supplement regularly. Between these two month we decided to do an Iron Study test and Peripheral Smear tests , results were as follows.

CBC Test:            March 10th, 2013 (age 23 months)
              June 2012                   FEB 12      March 10th, 2013
WBC             12.9                       10.3               10.6       
RBC               4.61                       5.73 * H          5.32
HGB              10.9                        10.5 *  L          10.5
HCT                29.3                      35.8*  L           31
MCV                63.5                     62.5*  L          58.3
MCH               23.6                      18.2  *L         19.7
MCHC               37.2                    29.1  *L          33.9
RDW               17.6                      16.4  *H          22.7

 Platelet           404                   421*H         301

Differential WBC

Netrophis     17*L
Lymphocytes   71*H
Moncytes        05*H
Eosinphils        06H
basophils        01*H

Peripheral Smear Test

Red Blood Cells exhibit anisopolklicoysis with mild hypochormia
- Microcytes polychromatophils and occasional target cells are present.
-lymphocytosis is evident, few activated lyphocytes are seen.
thormbotosis is evident, platelet morphology is normal
- no abnormal celss or haemoparsits seen.

advised
Iron Study
Ferritin
Haemoglobin Electrophoresis

IRON STUDY TEST

IRON             20 *L Ug/dl
TIBC              423
% Saturation    5 %.

Hemoglobin electrophersis test results

Haemoglobin A  97.70 %
Haemoglobin A2  2.3 %

I got two opinions from two doctors , the first doctor who did the electrophoresis test concluded my son has Iron Deficiency Anemia and I should watch his diet and give him more iron rich food.
The other doctor which is more older Hence more experienced who did his normal CBC test yesterday and found that even with iron supplement for 2 months did not increase his HGB. suggested he could be carrying thalassemia gene.?!!! I showed him the Electrophoresis test and how it shows everything is normal. He mentioned that electrophoresis test is not usually sufficient to detect Thal Minor. he said, he reads out the CBC test and can tell from the MCV and RDW etc that he might be Thal minor. Even after that he still prescribed him Iron supplement for another 30 days !!!

Now here are my questions, and kindly answer them because i am confused :
1- what more test I  could do to make sure he is not Thal minor? i did CBC , iron study, HGB electrophoresis
2- Looking on his CBC , can you tell if he is Thal Minor
3. Looking on his mother different CBC, could be she has Thal minor. ( knowing that she is pregnant now and has low iron)
        Pregnant        Not Pregnant (breast feeding)
WBC             11.8                       11.1               
RBC               4.96                       5.00         
HGB              10.8                        11.7         
HCT                36.2                      36.4     
MCV                73                       72.8
MCH               21.7                      23.5         
MCHC               29.8                   32.2         
RDW               14.3                      18.1         
Platelet           290                     307           
4.  how long for iron deficiency to be corrected after taking iron supplement.
5. is two month enough to correct the iron ferritin and HGB reading. Or should be on supplement more than 2 months.
6. is it normal that his electrophoresis test does not show HBG F reading.
7. can a person inherit Thal Minor from his grand parents.

Hope I explained well my child’s case.

Regards,

Just a minor advise,

Don't continue to give him iron supplements until iron panel is done and that it is detected that he is actually iron deficient and low hb is due to it and not thal minor. Excess iron is harmful for organs in long run.

-P.

It is possible that both IDA and thal minor are present. The most recent RDW is quite high, and would indicate IDA is currently present. I would suggest iron rich foods as opposed to supplements, as the iron is much easier absorbed when it is from foods. Eating foods rich in vitamin C will help absorption of iron in the gut. Iron supplements can be both harsh and ineffective. My own post surgery anemia was corrected by an iron rich vegetarian diet. It is possible and much easier on the digestive tract.

Is thal minor present? It is likely, considering the mother's tests also show the same range of values. The HbA2 can be affected downward in beta minors by IDA, so the low level does not rule out thal minor. DNA testing may be required to determine if thal is present. If DNA testing is done, it should be for both alpha and beta thalassemia.

Thanks Paratik and Andy for your reply.

Well, i got now more confused, Should I continue the supplement , my child does not eat much hard food.?

If Andy what you saying is correct. How can I make a definit sure he is Thal minor, knowing that he did not do yet his ferritin test nor TSH for the thyroid when he was born. (I thought the hospital already did but found out yesterday they did not) and other doctor missed out on Ferrittin test.

also, if he is sure Thal minor , is there any watch out for the food to be givin , what should I watch our for symptomps when he is growing up. How often should i visit his doctor for blood analysis.

Regards,

I would suggest an iron rich diet, as the iron supplements have not affected the iron level. There is a partial list of iron rich foods at http://www.thalassemiapatientsandfriends.com/index.php/topic,2415.0/highlight,iron+rich+foods.html
I would also suggest a daily folic acid supplement.