Thal minor, 30 weeks pregnant, low hg and high iron

Hello,

I am looking for some information and your website has been more helpful than any Dr. In fact luckily I had read your previous pregnancy posts when my drs tried to prescribe me 650 mg of iron daily the first time they pulled my CBC without checking my iron levels (to find they were normal). So, at 13 weeks my hg was low (9.2) and iron was normal. Now, at 30 weeks my most recent blood tests say my hg is,7.5 with an iron level of 202 (high). I am not taking any iron supplements. I understand my hg readings,may not be accurate because of dilution? My drs are in the least confused. They can't seem to wrap their heads around the low hg and high iron. They now want to check my b12 levels but the nurse couldn't tell me why and I'm still waiting on a call back from the Dr. Should I be worried? What should I do, if anything , to try to bring my hg up a bit. I really don't want a blood transfusion at allbut especially not with the baby still inside me. I do not feel tired, in fact I'm feeling better than I had the first two trimesters. Does the low hg have any negative effects on the baby? What about the high iron levels? I just want to make sure I'm as informed as possible as my drs surely aren't. Thank you for any informationyou can provide.

The doctors need to understand that the low hemoglobin level has nothing to do with iron deficiency. It is due to thal minor and minors will see their Hb drop during pregnancy and this is normal. I wouldn't worry about the iron reading of over 200. This has to be taken in the context with other iron tests and is not significant. You should however, be taking a high daily dose of folic acid, as much as 5 mg daily. This has far more to do with maintaining your Hb than iron, as foliate is needed to build red blood cells. If you tend to stay well hydrated, this will also lower your Hb due to dilution and also is not significant.

Generally, the rule is transfuse after two consecutive Hb readings of under 7. The condition of the patient also must be taken into account when thinking about transfusing. If the patient is doing well at an Hb above 7, then wait and see is  the best approach, but preparations for the event of a transfusion during the delivery should be made as a precaution.

As long as you are feeling good and not overly fatigued, the only intervention needed is take folic acid, eat a really good nutritious diet and get sufficient rest. If you suddenly feel very tired and fatigued, call your doctor and have your Hb tested.

Thank you Andy. I currently take 800 mcg of folic acid a day. How does that compare to 5mg? Do I need more?  I drink 2 to three bottles of water a day or sometimes up to a half a gallon of fat free milk. What do you think the Dr is looking for in the b12 test?

5 mg is 5000 mcg, so the dose is much higher. It is also quite safe. The best reports I have heard from thal minor pregnancies are those where high doses of folic acid were taken. Although 800 mcg may be (barely) adequate for those without thal during pregnancy, higher doses should be taken by thal minors when pregnant. I think the doctor is looking at your B12 number because more and more thal minors are being diagnosed with deficiency. I do recommend that all thals take B complex daily.

Update: so my folate level came back high... 20+ she said. Should I still take a folic acid supplement? If so, how much? She said it was up to me if I still wanted to take 1-2mg a day, on top of the 800mcg I take now. On a side note, did my 3 hour glucose today and passed 3 out of the four blood draws and they want me to repeat it... In a month. I'm 31 weeks. I know this isn't directly relayed to thalassemia but Im on the fence about repeating the test. It would be the third time and I feel so crappy after. Not sure I understand the point of repeating it again. Thanks for your help!