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Thalesemia Minor And Pregnant With Twins. Haemoglobin Has Dropped. Suggest The Iron Supplements To Be Taken?

Posted on Mon, 11 Nov 2013

Question: Hi
My wife is thalesemia minor and 20 weeks pregnant with twins. Her Hb has dropped from 10 to 9.1 in the last 2 months despite an iron XXXXXXX diet. What iron supplements would you suggest for her condition? Is orofer xt safe for her ?

Thanks
XXXX

Answered by Dr. Indranil Ghosh (8 hours later)

Brief Answer:
Iron may not work in thal minor

Detailed Answer:
Hi
Thanks for your query.
The anemia in thalassemia minor is due to a hemoglobin production defect and is not dependant on iron supplements. Pregnancy may cause some relative iron deficiency that is why it is routinely given. Orofer xt is safe in pregnancy. The folic acid dose may be increased. We need to keep a close watch on hb levels and if required, some blood transfusion may be required.

Hope I have answered your query. I will be available to answer further followup queries, if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (15 hours later)

Thanks for your reply.
I am concerned about the fact that free iron harm thal minor patients and supplements are seldom recommended.
In your view what is the safest iron form that can be taken.
Would you suggest Amway Nutrilite -iron Folic tablets.
What tests would you suggest we get done?
Thanks

Answered by Dr. Indranil Ghosh (4 hours later)

Brief Answer:
See below

Detailed Answer:
It is true that iron may harm thalassemia minor as they already have enough iron in their body. But in pregnancy, iron stores may be relatively low.
Hence, we may add iroon supplements fro the next few months. It is unlikely to cause much harm. We can also do serum iron tests to see the iron status.
All the iron supplements are quite safe. I don't know much about the Amway one.

regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (4 hours later)

Dear Dr. XXXXXXX
As suggested I got her tests done today. Here are the values

Hemoglobin- 8.7 (11.5-15)
Ferritin,Serum- 12.2 ng/mL(10.0 to 291)
Iron-63.39 ug/dL (50.0-170)
TIBC- 429.82 ug/dL (250.0- 425)

Other CBC parameters which are off the range are as follows

PCV - 27% (36 to 46)
MCV- 63.8 (80-100)
MCH- 20.6 (27-32)
MCHC- 32.2 (32-35)
RDW-16.3 % (11.5-14.5)
Lymphocytes- 18.1 (20-40)
Eosinophils- 0.9 (1.0- 6.0)
Abs Leucocyte count- 7.1 (2.0 - 7.0)

With her thal minor case, I am quite worried as most of the values are off the respective ranges at the 20 week stage. Going by quick dip in Hb levels over the last 4-5 weeks, this may worsen.
Kindly guide.

Thanks
XXXX

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
She merits a trial of iron

Detailed Answer:
Though the serum iron is ok, low ferritin suggests low body stores of iron. Hence we can safely try iron supplements. A close watch on hemoglobin is required and if it falls below 8 then blood transfusion may be required. There is no need to worry so much as this can definitely be managed.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (28 minutes later)

Dear Dr. XXXXXXX

Thank you so much for your time and advice.

Best regards
XXXX

Answered by Dr. Indranil Ghosh (8 hours later)

Brief Answer:
You are welcome

Detailed Answer:
If you do not need any further clarifications then please close the query and give feedback.

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar