Beta thala minor with hepititus B

Hi Andy,

My husband is a beta thala minor.  According to his molecular analysis he has the beta-thalassemia trait and he's heterozygous for the condon 41/42 (-TTCT) beta0-thalassemia mutation.

His hematology report is as follows:

Hemoglobin  136
Hematocrit  0.43
RBC  6.98
MCV  62
MCH  20
MCHC  315
RDW  17.6
WBC  5.3
Platelets 234
MPV  8.9

His RBC, MCV, MCH, MCHC and RDW are outside of the normal limits/ranges.  How does he fair as a BTM?  What is his red blood count?  He gets tired very easy and doesn't seem to have much stamina. 

He's taking 3mg folic acid, 2000 iu vitamin D, two B50s, omega 3, 400iu vitamin E, 500mg vitamin C daily.

Also he is a hepititus B carrier.  He contracted hep B when he was a kid and the doctor said it's dormant.  His liver is enlarged and he has a fatty liver.  His ferritin level is 358.  Our family doctor said he doesn't have iron overload because his liver is enlarged and therefore caused his iron level to be above the normal range.  The doctor said the only way is for him to exercise and lose 8-10lbs and then we'll see a signicant decrease in the numbers of his fatty liver, his liver becoming smaller and then his ferritin level will decrease as well.  Should my husband take some natural chelatin such as green tea/extract/IP6 to help bring down his iron level.  Will his iron level damage his organs?

I am just trying to understand his BTM and iron level to take better care of him.  Any feedback would be greatly appreciated.

Kayla

Kayla,

Your husband's Hb level is also normal. His levels all reflect what is expected in beta thal minor and are not of any alarm. The liver is often found to be slightly enlarged in thal minors as a result of high turnover of RBCs.The only other thing I would suggest is that he try supplementing 500 mg magnesium daily in addition to the other supplements, which are all good. This may help to slow the turnover a bit. Because his deletion is a beta zero, one might not expect such a healthy Hb level. In fact, modest anemia would normally be expected. Do you also have the results of a hemoglobin electrophoresis for him and has he been screened for silent carrier alpha? If he hasn't been screened for alpha, this must be done before continuing to try to get pregnant. The reason I mention this is because a co-existing alpha deletion can moderate beta minor, thereby producing a normal Hb level. A high production of fetal hemoglobin would also explain this. This would also explain his tiredness in spite of a normal Hb because fetal hemoglobin does not release oxygen as readily as normal adult hemoglobin, which can result in lack of endurance.

His ferritin is a bit high, but not enough to cause any problems. It may actually be high because of inflammation or infection. I would definitely suggest that he never take iron supplements. Besides their mild chelating affect, IP6 and green tea extract are excellent antioxidants, so he can consider taking them. As far as hepatitis, there are several herbal remedies of great value. Milk thistle is a common weed that has remarkable properties. Not only is it a good liver tonic but it actually helps to regenerate damaged tissue. It is well known as a treatment for hepatitis. Red clover and nigella are other herbs which are also helpful to the liver. Nigella is a common herb in southern Asian cooking and is also known by many other names. These can help to keep his hepatitis under control and not a factor in his life.

Hi Andy,

I am not sure if a hemoglobin electrophoresis was ever donon on my husband.  I can get our family doctor to do one on him if necessary.

The molecular analysis test was performed at the Provincial Hemoglobinopathy DNA Diagnostic Laboratory for genetic testing to rule out the possibility of us having a thala major baby.  We were told that I am an alpha thala minor carrier with two deletions on one chromosome and my husband is a beta thala minor carrier only and he is not a alpha thala carrier and that we are safe from having a thala major.  All of our children have a 50% chance of being a carrier of Alpha thala and a  50% chance of being a carrier of Beta thala.  The report for him states "The alpha globin gene cluster was analyssed by deletion specific PCR (-3.7/, -a4.2/, --SEA/, --FIL/, --THAI/, --MED/, -(a)20.5/,).  The patient being negative for these deletions.  However the possibility of other deletions or rearrangements or non deletional alpha thalassemia trait is not excluded.  I don't know how to read the deletions.  Do you know if he has been screened for a slient carrier alpha?

Thank you for your responses and dedication.  May God bless you!

Kayla

Hi Kayla,

The deletional forms of alpha thal have been ruled out by the test. The non-deletional have not. These are not as common, and are detectable with a different test, but that may not be necessary.

The patient being negative for these deletions.  However the possibility of other deletions or rearrangements or non deletional alpha thalassemia trait is not excluded.

Your husband may have already had an electrophoresis if his beta minor had been detected prior to the DNA testing. Its a routine test done if beta minor is suspected. The results will show percentages of the various types of hemoglobin found in the test. usually, you will see results for HbA, HbF and HbA2. If the HbA2 is higher than normal (>3%) and the HbF is measurable at 1% or higher, beta will be suspected. However, if an alpha mutation was also present, the HbA2 and HbF would be normal, so this would be one quick method to check if alpha is excluded. If his HbA2 is higher than normal, alpha carrier will almost certainly be ruled out. The high RBC, which is normal for beta minor would probably also be lower if alpha was present. He may be able to find out from his doctor's office if a hemoglobin electrophoresis has previously been done. The fact that the deletional types have been ruled out removes most of the possibility of any alpha trait.