Hi Andy and anyone who can help (and sorry for the long and detailed post!)
I'm hoping you can guide me a little here as I've become a nervous wreck since becoming pregnant for the first time. I thought I only had to worry about my age (almost 41), and never realised that being (beta) Thal Minor was also such an issue until I read these posts (all my life I thought I only had to avoid a partner with Thal Minor! thankfully hubby is all clear so one less worry). Now I stress every day, which I know isn't good either for myself or the baby. I am utterly scared about miscarriage and problems later on. I guess I'm looking for reassurance but also realism, as to how much I need to worry and what action I need to take.
So far ultrasounds show everything going well with the pregnancy, however I did have a small subchrionic haemtoma (SCH) at the beginning (shown at 8 week scan) which then appeared to heal itself by the 10th week and by the 12th week there was no sign of it.
Here are my blood results (tested at 10 weeks):
Hb 93 (yes quite low but midwife not overly concerned yet - I explained I'm Thal M and that can affect the result so I requested Iron Studies which they then agreed to do)
Platelet Count - 331
Haematocrit L 0.29l
Mean Cell Hb L 20.4 pg
Mean Cell Hb Concentration 320 gram/L
Iron Studies test:
Iron 28.6 mcmol/L (seems normal?)
Total Iron Binding Capacity Serum L51.0 mcmol/
Percentage Iron Saturation H 56.1%
Ferritin Serum * 44 micrograms (not sure if the asterisk is a bad sign!?)
Vit B12 Serum 535 nanograms
Folate Serum * >20.0 micrograms
I recall at the time of the midwife going through the NHS assessment of whether I was at risk of thrombosis, I didn't know enough at the time about Thal minor; I had recalled some association with clotting but not enough to warrant me saying anything for sure, so she didn't tick the boxes or refer me on for more testing, and later I checked the list and it only showed sickle cell as being a reason to be automatically referred to the Thrombosis team. She also said they only do iron transfusions if someone has low Hb, not blood transfusions.
She was a bit surprised at my low blood pressure at 12 weeks (I didn't get the exact figure from her) - but she said as long as I feel fine then it's ok - I had meditated that morning and meditation is meant to lower BP so it could have been that, or as you have said Andy, Thal M can tend to keep BP low.
My chinese acupuncturist says that I look a little too pale for her liking and my fingernail beds aren't as pink as she would like (that's the Thal and probably low iron state in pregnancy anyway), and I do get out of breath easily when going up the stairs but I usually had that pre-pregnancy also, though not as much. I have been tired often throughout first trimester (normal pregnancy symptom so I can't be sure how much is due to Thal M/low iron) and I can't do as much in one day as I used to (but I can still get out and about, I certainly don't need to stay in and sleep all day)
Due to the number of questions I have I will number them to make them easier to read/answer:
(please know that as annoying as all these questions might be, I will be ETERNALLY GRATEFUL if you took the time to answer them all, there's so much at stake for me being a first time mother at this age, not knowing if I will get the chance again...)
1. Am I less likely to miscarry if I am past 13 weeks or does that not make a difference if one is Thal Minor, because problems can usually occur later? Are stillborns more of a risk with Thal M?
2. The cleared up SCH is good news but I guess it shows I'm predisposed to more placental issues/possible clotting later on, would you agree? Or is it a good sign that my body was able to 're-absorb and repair' the clot?
3. I seem to have good/normal platelet count and I read somewhere that a normal platelet count indicates that you do NOT have a clotting problem, but I'm not sure if this is a reliable indicator?
4. Should I ask for regular Hb blood level checks and if I dip below 8 then I should get a blood transfusion (and not just an iron one?), or if they won't do regular testing then can I simply rely on gauging whether I feel suddenly dizzy or faint to go in for a checkup?
5. Although I don't ever feel dizzy or faint, I still struggle with doing a full day (long winter doesn't help), so I guess that's an indication of low iron - what do you make of all my blood results and whether I need extra iron supplementation/a blood transfusion?
(I can't tell if my iron is just acceptable or not (online figures are so confusing as different countries use different measurements and ranges) - the midwife wasn't concerned about my results, she said they're near normal especially my Iron, Iron Saturation levels, B12 and Folate levels, however I have little faith in western medicine especially re the intricacies around Thal - and actually it looks like Iron 28.6 is normal but 44 mg Ferritin is quite low!)
6. Should I change my folic acid supplements to l'methylfolate instead? (and do I need to keep taking them throughout the whole pregnancy? Is folic acid only needed for preventing neural tube defects which won't be an issue past 12 weeks or is it still needed in high quantities for a successful pregnancy due to my Thal M?)
7. Is my lower blood pressure a problem, how does low BP affect pregnancy and if so, what should I do about it - I guess it's better than having high BP right? ie. risk of pre-eclampsia, but then I read from you Andy that Thal can cause one to have low BP and therefore think all is ok on that front when in fact it may not be...
8. I read that O positive blood type (which I am) tends to be thinner blood and therefore blood thinners are not advised, that they can increase the risk of placental abruption instead of prevent it...what are your thoughts on this?
9. I am concerned about taking both Vitamin E and Aspirin as there have been studies showing birth defects from their use in pregnancy, though low dose aspirin seems to be ok I'd rather not take that risk if I don't have to...and the Vit E study said it was not considered safe even in daily recommended doses during pregnancy, though the study had flaws (don't they all?? just to make it doubly confusing!) - what are your thoughts?
10. If O positive blood is thinner, am I better off getting regular detailed ultrasounds instead to check for placental clots/blood flow issues rather than go straight on aspirin (which they recommended simply due to my age)?
11. Should I demand a thrombophilia test to rule out clotting disorders/antiphospholid syndrome before considering taking aspirin (or Heparin which they would put me on if a clotting disorder is confirmed)?
12. Is placental abruption only a risk if one has a clotting issue, or does low iron have anything to do with risk to the placenta? You mention a sudden drop in Hb being problematic - is that more for the mother's general health or also for the baby directly? Do you know what a sudden low iron dip does to a foetus and is it common enough for me to worry about? (I'm a worrier anyway as you can probably tell! ;))
13. Do you recommend Floradix as a natural iron supplement or should I start eating red meat again (I'm generally a veggie but am scared about ingesting undercooked meat)? I read that Floradix won't make a difference to Thal Minors due to how they metabolise iron, but from what you can see on my iron studies should I try taking it or will it risk iron overload? (which I've heard can have equally negative birth outcomes)
14. Can iron overload due to iron transfusions cause issues with placenta/baby?
15. If the baby has Thal Minor from me, will that affect anything during the pregnancy ie the foetus' survival?
16. In your opinion, is my combination of older maternal age and Thal Minor a recipe for disaster or do I still have hope??
Again, thank you SO MUCH in advance for taking the time to read/reply - I put a lot of effort into this post and am mostly looking for a response from Andy as he knows a lot about this topic but equally anyone is welcome to chip in to help me calm my nerves!
![Undecided :-\](http://www.thalassemiapatientsandfriends.com/Smileys/classic/undecided.gif)
Best wishes
J