Pregnancy update-iron issues again

So I am 24 weeks pregnant, beta thal minor,  and have been taking 5 mg of iron (as ferrous sulfate, purabsorb iron water) with orange juice on an empty stomach every morning.  I was referred to the hematologist at the beginning of my 2nd trimester when my hemoglobin dropped from 11 to 9.9.  6 weeks ago the hematologist checked my iron and it was a 48, which I was very happy about, I struggled with my iron during my fist pregnancy and needed iron transfusions.  The hematologist said she wanted to keep an eye on both my hemoglobin and iron levels and said she would do a blood transfusion if I dropped below a hb of 9.  Yesterday I got my new labs back and my hemoglobin is 9.8, but my iron dropped to 23, and my binding number went up, didn't catch the number on the report.  The hematologist wants to see me again in 2 weeks and is planning to start iron transfusions.  I said in the meantime I would double my iron daily to see if it would help.  She seems to think my body does not absorb iron very well.  I eat meat everyday and try to eat as much fruit and veggies as I can, I also cook with cast iron.  Any other suggestions?  Is this common for thal?  Is my iron dose too low?

Thal minors have iron that floats freely in the bloodstream that isn't absorbed right away. Sometimes all of a sudden your body will start to process it and your iron levels spike. That's why they don't usually recommmend taking iron supplements if youre thal minor... I'm 30 weeks with my hg at 7.5 but they haven't even mentioned doing a transfusion due to the fact that sometimes our hg counts are not accurate because of all of the extra blood in our bodies during pregnancy. But, if it worked for your first pregnancy and everything went well you might want to do the same as last time. It's so tough when drs aren't properly educated but pretend they are...

Thanks eby14, it's interesting to hear how differently thal is handled from doctor to doctor.  I was able to hold off on the iron transfusion at my last appointment as my numbers maintained.  During my first pregnancy they didn't mention a blood transfusion unless my hb went below 8. It's the same hematologist too, so I don't know what changed in 2.5 years.  She did however give me iron transfusions every 2 weeks in the 2nd trimester and part of the 3rd.  I figured out the number she was referring to with my iron at my previous appointment was my hematocrit, so at least I know that now.  How is your energy level with hb 7.5?  Good luck with the rest of your pregnancy, and thanks for the post!

Hematocrit is no indication of iron level. The values they would look at when properly testing for iron would be serum ferritin, serum iron and either TIBC (total iron binding capacity) or iron saturation. If iron is needed, your body will respond with a higher hematocrit and Hb. Transfusion should be reserved for the cases where a woman is having real quality of life issues and inability to function due to the anemia. If a woman's Hb drops below 8 AND she is having significant problems with energy, a transfusion might be warranted.

I actually feel pretty good, especially compared to how I felt the first trimester. In tired sometimes but that's been the story of my entire life lol. I find myself out of breath more often but I think that's due to the little ones position more than my hb. My doctor Said that unless I suddenly feel exhausted, they won't test my hb again until I go into labor, only because our hb can change from day to day and it may not even be accurate because I drink a lot of fluids in a normal day. Mist recently though my Dr tested my b12 and folate levels. My b12 came back normal but my folate came back high. Andy recommends taking 5mg of folic acid a day but now Im not sure what to take.