Beta Thal Minor and Iron Infusions

I've known that I've had beta-thalassemia since I was a teenager. I'm now in my early thirties, a couple of years ago I was diagnosed with a provoked PE after having a cholecystectomy. My doctors at the time didn't feel that a workup was necessary. I moved and my new doctor felt that I should see a hematologist due to my continual iron deficiency despite using iron pills. I saw a hematologist and he thinks I would benefit from having two IV iron infusions. My labs don't look as bad as they have in previous years, but physically I am feeling worse. I was just wondering if I could get someone else's thoughts based on my labs? Thanks!

Lab   Result   Range   Source

Unsaturated iron binding capacity measurement (Iron, % saturation)
17.2%   20.0 - 50.0   Serum

Basophil, percent (BA %)
0.3%   0 - 1.0   Whole Blood

Eosinophil, percent (EO %)
4.8%   0 - 3.0   Whole Blood

Lymphocyte, percent (LY %)
29.5%   15.0 - 41.0   Whole Blood

Neutrophil, percent (Neu %)
58.8%   40.0 - 77.0   Whole Blood

Plt Est (Platelet estimate)
Agrees with Analyzer      Smear

Monocyte, percent (MO %)
6.1%   3.0 - 11.0   Whole Blood

Hemoglobin F (Hgb F)
0.6%   0 - 0.9   Whole Blood

Hemoglobin S (Hgb S)
0%      Whole Blood

Hemoglobin C (Hgb C)
0%      Whole Blood

Hemoglobin A2 (Hgb A2)
5.6%   1.7 - 3.5   Whole Blood

Hematocrit determination (HCT)
36.8%   37.0 - 47.0   Whole Blood

(Platelet morphology)
Normal      Smear

Red cell distribution width determination (RDW)
15.1%   10.5 - 14.5   Whole Blood

Mean corpuscular hemoglobin concentration determination (MCHC)
31 g/dL   33.0 - 37.0   Whole Blood

Mean corpuscular hemoglobin determination (MCH)
20 pg   27.0 - 31.0   Whole Blood

Platelet count (PLT)
475 x 10^3/uL   130.0 - 400.0   Whole Blood

Basophil count (BA #)
0 x 10^3/uL   0 - 0.2   Whole Blood

Eosinophil count (EO #)
0.4 x 10^3/uL   0 - 0.3   Whole Blood

Monocyte count (MO #)
0.5 x 10^3/uL   0 - 1.0   Whole Blood

Lymphocyte count (LY #)
2.2 x 10^3/uL   1.2 - 3.4   Whole Blood

Mean corpuscular volume (MCV)
64.7 fL   81.0 - 99.0   Whole Blood

(MPV)
----      Whole Blood

Hemoglobin determination (HGB)
11.4 g/dL   12.0 - 16.0   Whole Blood

White blood cell count (WBC)
7.3 x 10^3/uL   4.8 - 10.8   Whole Blood

Red blood cell count (RBC)
5.69 x 10^6/uL   4.2 - 5.4   Whole Blood

Neutrophil count (Neu # (ANC))
4.3 x 10^3/uL   1.5 - 6.5   Whole Blood

(Hgb A, %)
93.8%   95.0 - 100.0   Whole Blood

(NRBC, #/100 wbc)
0 #/100 wbc      Whole Blood

Granulocytes, immature, automated, % (IG %)
0.5%   0 - 0.5   Whole Blood

(NRBC %)
0 /100 wbc      Whole Blood

Other hemoglobin (Hgb other 1)
0%      Whole Blood

(Hgb electrophoresis interpretation)
Results Below      Whole Blood

Alkaline phosphatase measurement (Alkaline phosphatase)
85 U/L   46.0 - 116.0   Plasma

Albumin measurement (Albumin)
3.6 g/dL   3.4 - 5.0   Plasma

Potassium measurement (Potassium)
3.8 mmol/L   3.5 - 5.1   Plasma

Bicarbonate measurement (CO2)
20.5 mmol/L   21.0 - 32.0   Plasma

Glucose measurement (Glucose)
78 mg/dL   74.0 - 106.0   Plasma

Calcium measurement (Calcium)
8 mg/dL   8.5 - 10.1   Plasma

Creatinine measurement (Creatinine)
0.7 mg/dL   0.6 - 1.3   Plasma

Chloride measurement (Chloride)
112 mmol/L   97.0 - 107.0   Plasma

Urea nitrogen measurement (BUN)
16 mg/dL   7.0 - 18.0   Plasma

Sodium measurement (Sodium)
146 mmol/L   136.0 - 145.0   Plasma

(Factor V Leiden mutation results)
Normal      Whole Blood

(Factor V Leiden mutation reference range)
Results Below      Whole Blood

(Factor V Leiden comments)
Results Below      Whole Blood

Albumin/Globulin ratio (A/G ratio)
0.9   0.8 - 2.0   Plasma

Alanine aminotransferase measurement (ALT/SGPT)
30 U/L   14.0 - 59.0   Plasma

Iron measurement (Iron)
48 ug/dL   50.0 - 170.0   Serum

(TIBC)
279 ug/dL   250.0 - 450.0   Serum

Microcytes (manual) (Microcytosis)
3+      Smear

Poik (manual) (Poikilocytosis (shape))
1+      Smear

Anisocytosis (manual) (Anisocytosis (size))
1+      Smear

Hypochromia (manual) (Hypochromia)
3+      Smear

Globulin measurement (Globulin)
3.9 g/dL   2.2 - 4.2   Plasma

(BUN/Creatinine ratio)
21.6   6.0 - 25.0   Plasma

Bilirubin, total measurement (Bilirubin, total)
0.3 mg/dL   0.2 - 1.0   Plasma

Aspartate aminotransferase measurement (AST/SGOT)
19 U/L   15.0 - 37.0   Plasma

Ferritin measurement (Ferritin)
45 ng/mL   8.0 - 252.0   Serum

(Sickle cell identification, solubility method)
Not performed      Whole Blood

(Prothrombin 20210 comment)
Results Below      Whole Blood

(Acid hemoglobin electrophoresis)
Not performed      Whole Blood

(Anticardiolipin, IgM)
<10.0      Serum

(Anticardiolipin, IgA)
<10.0      Serum

Granulocytes, immature, automated (IG #)
0.04 x 10^3/uL   0 - 0.03   Whole Blood

(Prothrombin gene mutation reference range)
Results Below      Whole Blood

Teardrop cell measurement (Teardrop cells)
Occasional      Smear

(Schistocyte)
Occasional      Smear

(Prothrombin-20210A mutation)
Normal      Whole Blood

Glomerular filtration rate, calculated (GFR estimate)
105 mL/min/1.73m2      Plasma

(Anticardiolipin antibodies, IgG)
<10.0      Serum

(MTHFR interpretation)   See Note      Whole Blood

Protein measurement (Total protein)
7.5 g/dL   6.4 - 8.2   Plasma

First, gallbladder removal is common in thal minors, as the higher turnover of red blood cells causes excessive bilirubin production, which in turn causes gallstones and sludge in the gallbladder. You may not have ever been told about the connection.

Your iron numbers are not significantly low. I'm not sure infusions are justified. Have you had infusions before or been on oral iron for extended periods of time?

L-methylfolate may help more than iron. I would suggest trying 2000-5000 mcg daily to see if you feel any better. A sublingual B-12 tab should be taken, as well. I would suggest trying this before you take iron infusions.

Thanks for your response!

Yes, I’ve been on iron tablets for a year and a half now, taking them twice a day. I think the hematologist thought process is that if I can get my iron stores up, I would feel better and wouldn’t have to keep taking the iron so often. I’ve never had iron infusions before, but I have always struggled with iron deficiency anemia. I have heavy menstrual cycles which drops my hgb and iron levels. This is actually the highest it’s been in a while. I have also been taking methylfolate as well as a multivitamin (it does not have iron in it), magnesium, vitamin D, probiotics, biotin, and milk thistle (both my parents had issues with their livers and during my cholecystectomy, they did a liver biopsy which showed early inflammation).

I hesitate to recommend iron infusions, as many patients have reported the infusions are tough on them physically. I usually will recommend trying Spatone Iron water before settling on an infusion.