Can you stand to review one more set of blood test results?+supplement questions

Component    Your Value    (Standard Range)
Ferritin   49.2 ng/mL   (3.0 - 151.0 ng/mL)

Reticulocyte Auto %   2.2 %   (0.5 - 2.7 %)
Absolute Auto Reticulocyte   118.5 10*9/L   (27.0 - 120.0 10*9/L)
Retic HGB Content   24.0 pg   (29.7 - 36.1 pg)
Transferrin   276.7 mg/dL   (200.0 - 380.0 mg/dL)
WBC   8.6 10*9/L     (4.5 - 11.0 10*9/L)
RBC   5.35 10*12/L   (4.00 - 5.20 10*12/L)
HGB   11.7 g/dL   (12.0 - 16.0 g/dL)
HCT   36.6 %   (36.0 - 46.0 %)
MCV   68.4 fL   (80.0 - 100.0 fL)
MCH   21.9 pg   (26.0 - 34.0 pg)
MCHC   32.0 g/dL   (31.0 - 37.0 g/dL)
RDW   18.3 %   (12.0 - 15.0 %)
MPV   9.7 fL   (7.0 - 10.0 fL)
Platelet   216 10*9/L   (150 - 440 10*9/L)
Variable HGB Concentration   Slight     (Not Present)
Absolute Neutrophils   6.1 10*9/L      (2.0 - 7.5 10*9/L)
Absolute Lymphocytes   1.7 10*9/L      (1.5 - 5.0 10*9/L)
Absolute Monocytes   0.4 10*9/L      (0.2 - 0.8 10*9/L)
Absolute Eosinophils   0.1 10*9/L      (0.0 - 0.4 10*9/L)
Absolute Basophils   0.1 10*9/L      (0.0 - 0.1 10*9/L)
Large Unstained Cells   2 %   (0 - 4 %)
Microcytosis   Marked     (Not Present)
Anisocytosis   Moderate     (Not Present)
Hypochromasia   Moderate     (Not Present)
VIT D2 (25OH)   <5 ng/mL   ng/mL
VIT D3 (25OH)   37 ng/mL   ng/mL
Vitamin D Total (25OH)   37 ng/mL   (20 - 80 ng/mL)
Vitamin B-12   457 pg/ml    (193 - 900 pg/ml)
Free T4   0.98 ng/dL     (0.71 - 1.40 ng/dL)
TSH   3.000 uIU/mL   (0.600 - 3.300 uIU/mL)

Hello everyone, I’ll try not to make this a book-length explanation. 

I found this forum about 10 years ago on a search for the source of my constant fatigue. I remember also writing to the Cooley’s Anemia Foundation at that time and they sent me a bunch of brochures and told me thal minor is asymptomatic. I wish I had explored the forum more then because I think it would have helped me in the intervening years!

I recently went for a physical due to increased fatigue (over and above the “usual fatigue”) and reduced running performance (usually pretty consistent) plus heart palpitations*, brain fog, memory issues. After being afraid I was dying of something and tons of frantic googling, I found myself back on this forum, reading about others with some of my same symptoms (heart palpitations, for instance).  (*I should note I'm seeing a cardiologist to rule out any other issues.)

I’ve now concluded that the current fatigue is a combination of aging (45 yo) + pregnancy (4.5 years ago) + breastfeeding + lack of adequate sleep for last 5 years (4.5 year old still only recently started sleeping complete nights) + some intensive marathon training  = complete depletion of my body’s stores & therefore the need for vitamin/mineral supplementation.

Andy, if you can stand to review one more set of blood work, can you tell me if anything stands out about the values above?  Are there additional tests I should ask for? I found it odd that, after a discussion of iron levels with my (new) doctor, there was nothing like Serum Iron tested. Is Ferritin an accurate measure of having enough iron? I would guess that like most thal-minors, insufficient iron is not the problem, but I wanted to be sure.

Regarding my Vitamin D level – I should note I live in the Southeast U.S. and get plenty, plenty of sunshine.

Andy, I’ve been reading your recommendations on supplements and have a few questions. Which supplement would it likely be best to start with? Vitamin D?  Frankly my impulse is to start taking everything all at once because I want to FEEL BETTER NOW!! but I know that’s no good way to track the cause if there are any adverse effects.

In terms of Vit D, is there a dose I should start out with?

Magnesium—it should be combined with calcium? 2 (cal) to 1 (mag) ratio, is that correct? Is there a supplement you would recommend that combines the two or is it better to take them separately?

Thanks everyone, and Andy for all you do on this forum and the Facebook page.

ATAV,

Ferritin by itself is not a good indicator of iron status for a thal minor. Your level is fine, so I wouldn't worry about iron. Get it from your diet.

Your D level is minimally okay, but should be raised. I would suggest 5000 IU daily. If that doesn't bump the level up much, you might want to try 50,000 IU once weekly. I switched to that last winter and finally feel like I'm getting enough D.
Your B12 looks good because it's midrange, but thal minors do better when it is closer to the high end of normal. A sublingual supplement can help you raise the level and can help with energy.
I would suggest taking calcium only if your diet is lacking. It isn't hard to get enough. If you feel you do need it, a 2:1 ratio is recommended by some, but a 1:1 ratio is recommended by others. I take 500 mg right before bed at night and it calms my restless legs and helps me sleep. I also take my zinc/copper supplement at the same time, so that may add to the effect. Since taking zinc and a high dose of D, my immune system has been great.

The one supplement I feel is absolutely essential as thals age is L-carnitine or L-arginine. It can help improve Hb over time and also is critical for maintaining the health and function of the circulatory system by increasing the amount of nitric oxide, NO in the body. You may never even notice an effect, but what is does is essential and should be considered a necessary supplement for all types of thalassemia. It may be the most important supplement as thals age.

Thanks for your response, Andy. I asked about the magnesium-calcium ratio because I understood from your nutrition post that a balance was important for proper cardiac function. The heart palpitations seem to have gone away for now, but I didn't want to do anything to throw off heart rhythm. I eat enough dairy, I think, to get adequate calcium. So should I just try the magnesium on its own?

One other factor that i wonder if you have thoughts about: a sort of "last straw" perhaps, for my body, was being prescribed Cipro last fall after a spider bite began to develop cellulitis. After learning about Cipro, I regret taking it and wish I had been a better proponent for my own health. Anyway, I'm just left wondering what long-term effects it may have had, as it was (seemed to me) a pretty high dose. 750mg 2x daily. I figure that would likely wipe out all the good gut bacteria necessary for nutrient absorption. I took a probiotic off and on for a bit, but not until months afterward, and I never really noticed a difference.

Is there a source for l-methylfolate you prefer, or can it be purchased pretty much anywhere?  Same with L-carnitine. I don't know whether to just pick something off of the shelves at Whole Foods or what.

Adriana

I too, cannot tolerate cipro. After two days, I thought my stomach would explode and the doctor took me off it. I was on a common antibiotic earlier this year for a tooth infection and I am still working on restoring my gut bacteria. I take probiotics daily and eat yogurt often, but have learned that restoring the gut won't happen overnight.

If your diet includes sufficient calcium, you may be fine without a supplement. You are unlikely to get adequate magnesium without a supplement, though. I would advise to keep doing what you're doing, since it has helped with the heart palps.

Any brand of L-methylfolate will do, as long as it is a quality brand. I often check the "About" section of a website to learn about a compnay's history before ordering supplements.