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Author Topic: Thal Minor and Pregnancy  (Read 24674 times)
thalmom
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« on: February 16, 2009, 02:41:09 AM »

Hello all, I am new to this website and very grateful for all your expertise.  Here is my scenario:

I am a 38 year old female and have Beta Thal Minor, my only record before 2005 is HGB 10.0 and Ferritin 72.  I got pregnant in late 2005 and miscarried around 3 months, around 2 months I was HGB 8.3 and retic count 2.5

I got pregnant again about 6 weeks later in Feb. 06 (too soon, now I realize).  My HGB dipped into the 7's and I had a transfusion, got up to 9.8.  A couple months later, I was back down to 7's and got another transfusion got up to 9.1.  I felt really bad during pregnancy; now I wonder if these transfusions were truly "necessary" or just to make me more comfortable?  I delivered a very healthy full term little boy by c-section and has another transfusion 24 hrs. after delivery.  TOwards the end of my pregnancy the HGB got down to 8's and after the post-op transfusion up to 9.7.  My retic count was anywhere from a 2.6 up to 4.5 down to 2.7 towards end of pregnancy.

SInce, then I've been worked up every which way to Sunday to figure out what is going on since I also seem to have iron def. anemia and don't absorb much iron even with the horse pills and prenatals which I've taken for 3 years now.

At beginning of my pregnancy my serum iron was 106, 6 months after delivery it was 42 and has continually dipped and back up for the next 2 years down to 29, 26, 39 and then 48, now 79. 

Ferritin during early pregnancy was 74 and then 92, post delivery for the next 2 years it was 267, 150, 152, 156, 179 and now 131.

Most concerning to me is retic. count which 6 months post delivery (early 2007) was .7 up to 1.0 in 5/08 and now .6.  It had been much higher during my pregnancy.

I had a bone marrow biopsy a couple months ago, it was normal.

We really want to have another baby - is anything here of concern to any of you?  Will I have the same type experience with needing transfusions again?  PLEASE HELP!!!  I don't trust any of the doctors any more and we have moved to another state so dealing with all new docs now...

PK
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Zaini
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« Reply #1 on: February 16, 2009, 03:33:50 AM »

Hi Thalmom,

 

As for right now,i don't think you have iron deficiency,because both your Serum Iron and Ferritin are in normal range.

Quote
At beginning of my pregnancy my serum iron was 106, 6 months after delivery it was 42 and has continually dipped and back up for the next 2 years down to 29, 26, 39 and then 48, now 79.

From http://www.nlm.nih.gov/medlineplus/ency/article/003488.htm#Normal Values

Quote
Normal Results   

Iron: 60-170 mcg/dl

Quote
Ferritin during early pregnancy was 74 and then 92, post delivery for the next 2 years it was 267, 150, 152, 156, 179 and now 131.

From  http://www.nlm.nih.gov/medlineplus/ency/article/003490.htm#Normal Values

Quote
Normal Results   

Male: 12-300 ng/mL

Female: 12-150 ng/mL

So please watch before taking iron,because extra iron can be harmful.

About transfusions,yes thal minors may need transfusion during pregnancy sometimes,I think these transfusions helped you through out your pregnancy.I am a thal minor myself an my hb went as low as 7 in my first pregnancy,but my thal wasn't diagnosed at that time,so they treated me with iron instead of transfusion.

I suppose since you were on pre natal vitamins it must contain folic acid? Folic acid is a must for every thal.

As for pregnancy complications regarding thal,i'll advise you to check this thread,

http://www.thalassemiapatientsandfriends.com/index.php?topic=1399.msg11365;highlight=thal+minor+pregnancy#msg11365

Hope this helps,please feel free to ask any questions you have in mind.

Zaini.
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« Reply #2 on: February 16, 2009, 05:24:43 AM »

Hi Thalmom ,
  ..

Umair
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Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.

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Sharmin
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« Reply #3 on: February 16, 2009, 07:07:24 AM »

Dear Thalmon,

Welcome to thalpal!  It is quite common for thal minors to become significantly anemic during pregancies, and this anemia can become more pronounced with subsequent pregnancies.  I became very anemic during my pregnancies as well.  One reason for this is the the baby uses up iron and the mother provides nutrients to the baby - because thal minors are anemic already they can become further deficient during pregnancy.  Secondly, during pregnancy the plasma volume increases therefore hemoglobin becomes diluted therefore in blood tests hemoglobin appears lower than it actually is.  A third factor is that the spleen can become enlarged in all thals, and in pregnancy it can become further enlarged as it increases it's surface area to create more hemoglobin.  As thals make irregular blood cells - the spleen causes hemolysis to occur as well. 

During pregnancy, regular maternal vitamins should be taken - a balanced diet which includes iron rich foods such as broccoli, spinach and meat can be consumed - but high iron supplements should not be taken. 

I hope that this helps and best of luck in planning your second child,

Sharmin
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« Reply #4 on: February 16, 2009, 09:49:29 AM »

Hi Thal Mom

I think your report seems to be ok. My hb was aroud 8 to 9 in both my pregnancies and in my second C section it dropped to 7. Docs asked me wether I wanted a transfusion or not, as i did not feel any symptoms i said let me try to bring it up with supplements. In 2 months it was up to 10.5. So i think if you can manage and if your Docs are ok with it, you can also try to get your hb up by supplements.

You can try fresh wheat grass juice it is a good hb inducer. Donot miss folic acid. Also check with your doc wether you need iron.

Thanks

Puja

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Dori
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« Reply #5 on: February 16, 2009, 04:20:20 PM »

HI Thalmom,

This is first a question to the others here. I read recentely at the CAF site about a project of thal (minor?) and pregnancies. I thought they were searching for people to come into that trail. It was in one of the last CAF newsletters, but I have already sent all my old mails to the moon. I can not refind this news, but I am sure I have read it. Has anyone an idea?

@ Thalmom: Did you take folic acid during your pregnancies? I have heard you must start with it 3 months before...

Best wishes,

Dore
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Zaini
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« Reply #6 on: February 16, 2009, 05:18:49 PM »

Dore you are right,there was a study being done,but that study was about thal major pregnancies.

Zaini.
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thalmom
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« Reply #7 on: February 17, 2009, 01:05:31 AM »

Thank you all SO MUCH for your helpful responses.  My hemoglobin has never been above 10 and does not have any hope of getting beyond 10.  My prenatal during pregnancy had about 800 mcg folic acid which probably is OK for the average person and not sufficient for me.  Since I discovered your site last night, I have upped this amount by another 400 mcg, 1200 total.  I am hoping this builds up my reserves.

My serum iron has just recently broken through the low end of normal, which means it's still OK to take prenatals with 30 mg iron?  I am seeing a new hematologist this week and I'll ask him.

I also took Floravital llquid iron during some of my pregnancy; does anyone have experience with this pproduct?  My midwife friend told me it's a much more absorbable form of iron so you don't need as much, but maybe it was not enough after all...

As far as ferritin, it has been higher than normal range the last couple of years combined with low serum iron, what does this mean?  They are both normal now, finally, 2 years post giving birth... which is I hesitate in getting pregnant again and upsetting the balance...

And does anyone have advice on the retic. count?  Is this something that will trip me up if I get pregnant again?

wheatgrass, does this come in a bottle or capsule form?  I don't think we have it around here (Dallas, Texas); should I look into growing it?

My objective is to do everything possible to be in tip top shape in the next 3 months and then consider pregnancy if my levels really improve.  Because if it is the same experience I had before (very miserable), I would rather just stay with one perfect happy and rambunctious child than to risk all this again!!!  Not to mention my mom died suddenly of a brain aneurysm at 42 with a 2 year old (my sister); scary to approach that age...

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Andy Battaglia
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« Reply #8 on: February 17, 2009, 02:55:32 AM »

Hi thalmom,

Do you have other iron panel results, specifically the TIBC (total iron binding capacity)? Your serum iron has stayed in the normal range of 20-150, but your ferritin has been slightly higher than normal over several tests. I don't really see anything that says iron deficiency here, but TIBC would shed a bit more light on it. However, you may still need iron supplements during pregnancy to make sure blood production for the baby is normal. Some possibilities for readings like this are chronic inflammatory disease (such as arthritis or asthma), hypothyroidism, and type 2 diabetes. Pregnancy also affects the iron tests, so the results during pregnancy may be different from when you're not pregnant, without having any real implications.

Blood transfusions given to thal minors during pregnancy are done out of necessity and the Hb should not be allowed to drop below 8. Below this point, any sudden drop in Hb level can prove dangerous to mother and child, and sudden drops can occur, and with thal minor, anecdotal reports I receive here and through talking to thal minor moms has made me realize that thal minors should have special monitoring during pregnancy for Hb level and also for any signs of thrombosis (blood clots). I have read the article about thal minor and pregnancy and disagree with the conclusion that thal minors have no more problems during pregnancy than do non-thals. I disagree because at least half of the thal minor moms I have talked to have had one or multiple miscarriages. The non-thal carriers do not have this high incidence of miscarriages. It is well known that the hypercoagulable state exists in thal major and intermedia, but again thal minor is ignored. However, to a lesser extent, the same properties of red blood cells exist in minor that exist in major, small misshapen cells and an excess of alpha globin chains that have insufficient beta globin chains to combine with. This "clutter" produced by the small RBC's and the excess alpha chains lead to a state where clotting of the blood takes place more easily. It is known that in thal major pregnancies, thrombosis can lead to miscarriage as the thrombosis results in less circulation between the placenta and uterus. If this circulation is too weak to support the fetus, a miscarriage takes place. Whether it is ever proven, the anecdotal reports suggest this is also occurring in thal minors on a regular basis. If you do get pregnant I would highly recommend taking vitamin E supplements and also a daily aspirin (as long as your doctor agrees), as both act as blood thinners and vitamin E is also an essential nutrient that you should probably be taking daily already as it is necessary for so many functions including improving the health of the circulatory system and the heart. B complex is also very important for the production of red blood cells and may help keep your energy levels higher. Folic acid can safely be taken in doses up to 10 mg daily, so you can easily raise that also. 2-5 mg daily is recommended.

As far as the reticulocyte count, the normal range is .4-1.8% so you are in the normal range. When it was higher, it was a response to low Hb levels.

I agree that you should work to get your body in shape for a pregnancy and that supplements can help. Wheatgrass tablets are easy to find and are effective, as is the wheatgrass supershots from wheatgrassactive.
http://www.iherb.com/ProductDetails.aspx?c=1&pid=4993
http://www.grassfactor.com/order.htm

A good source for vitamins is Puritan.com. Good quality and good prices. You can also find many other quality sources for supplements online.

I think with some preparation and some precautions during pregnancy that you can have a healthy safe pregnancy. If you do get pregnant, ask your doctor to watch for any signs of thrombosis, as other medical measures can also be taken to prevent problems if they do develop.
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thalmom
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« Reply #9 on: February 19, 2009, 12:01:34 AM »

Hello and thank you so much for your very thorough response.

I will be ordering the Vit. E and Wheatgrass right away.  It's so interesting to hear about the blood clots as no doctor has ever mentioned that to me before.  Is that an issue for just any Thal Minor or just during pregnancy?  I wonder if I should be on the Vit. E and Aspirin anyway...

I only have one saturation rate during pregnancy, 38 about 3 months in.  Post pregnancy, for the last 2 years it's been 15, 13, 14, 17, 19 and now 32.  Does this tell you much?

Thanks again for all your help, everyone!

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Zaini
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« Reply #10 on: February 19, 2009, 03:07:27 AM »

Hi thalmom,

One thing to remember,when you order Vitamin E please check that it's natural and not synthetic,natural Vitamin E is more easily absorbed in the body,and large amounts of synthetic Vitamin E can be harmful.
Natural Vitamin E says d-alpha tocopherol on it,and synthetic one says dl-alpha tocopherol,so please check this out before buying Vitamin E supplement.

Zaini.
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Andy Battaglia
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« Reply #11 on: February 19, 2009, 03:51:35 AM »

I think you will find few doctors who are even aware that a hypercoagulable state exists in thalassemia major and intermedia, but it is well established. Minors have been ignored in most research, but we have heard many times in this group is that minors often have health problems that are not connected to thal minor by their doctors, even though so many minors report the same symptoms. The issue of hypercoagulability of blood and thrombosis is one of these issues. One contributing factor to this is the excess alpha globin chains that do not have an equal amount of beta globin chains to match with, because all thals, minor through major, do not manufacture equal amounts of the two globins, as non-thals do. The excess alpha chains in thal minor are fewer than with major, but depending on the beta mutation, they can still be a significant amount. In beta zero minor, there can be twice as much alpha as beta globin. This excess contributes to the clotting problem. The full mechanics of the hypercoagulable state are not completely understood and various factors are known contributors, but it is known that this state contributes to miscarriage in thal major and intermedia. Due to the very high number of thal minor moms who have told me about multiple miscarriages, I believe that thrombosis is a possibility for thal minors during pregnancy and that some simple steps like vitamin E and aspirin may help prevent this. This subject has come up before concerning minors but as usual with anything minors have to deal with, it is for the most part, being ignored by the medical profession.

There is one study I know about that does examine thal minor and thrmbophilia during pregnancy.

http://www.pulsmedia.ro/article--Clinic-Congenital_thrombophilia_and_minor_thalassemia_in_pregnancy--4790.html

Quote
The purpose of this work was to emphasize the key role of thrombophilia and bethathalasemia during pregnancy and the fetal outcome. The assessment of the pregnancy associated pathology and correct therapeutically approach is essential. Based on clinical findings, medical history, coagulation abnormality and placental abnormalities, it was diagnosed one cause of thrombotic accidents and was prevented the fetal complications of placental thrombosis in the context of chronic anemia secondary to Thalassemia...
Conclusions
- The clue of diagnostic of thrombophilia in this case was the placental micro-vascular thrombosis and dysfunction in the context of abnormal usual coagulation tests (decreased aPTT).
- Thrombophilia is responsible for spontaneous abortion and during pregnancy for preeclampsia, intrauterine growth retardation, uteroplacentar apoplexy (abruptio placentae), intrauterine demise, premature birth and venous or arterial thrombosis. Women with presented conditions in medical history should be assessed for thrombophilia.
- Antiphospholipidic syndrome is also developed after the delivery and needs close monitoring in the future - In the presence of chronic anemia and subsequent chronic fetal hypoxia, abnormal fetal cardiac variability, the evolution of labor is altered, the maternal-fetal interface being altered. The abnormal pericervical umbilical loop amplifies and reveals the effect of these conditions.
- The modality of delivery is influenced strongly by the associated pathology, complications and by the evolution of maternal fetal condition.
- Because the risk of VTE is high - low dose of aspirin is indicated and during pregnancy - anticoagulant therapy.

If a doctor reads this, he will understand what should be checked during the pregnancy.

Some relevant links on this site:
http://www.thalassemiapatientsandfriends.com/index.php?topic=1937.msg16226#msg16226
http://www.thalassemiapatientsandfriends.com/index.php?topic=109.msg535#msg535
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Andy

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roxiana18
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« Reply #12 on: February 27, 2010, 02:36:15 AM »

Hello

I wanted to start a new post but coudent find my way. My question is, what are the chances of a B thal Minor having a normal delivery. Do B thal minors have greater chances of C section deliveries. I am in my 7th month now and have an HB of 9.8 .
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Andy Battaglia
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« Reply #13 on: February 27, 2010, 08:49:48 PM »

Hi roxiana18,

This has been studied. A summary of the study can be seen at http://www.ncbi.nlm.nih.gov/pubmed/15172864

Quote
Beta-thalassemia minor during pregnancy.

Sheiner E, Levy A, Yerushalmi R, Katz M.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel. sheiner@bgumail.bgu.ac.il

OBJECTIVE: To investigate pregnancy outcome of patients with beta-thalassemia minor. METHODS: A population-based study comparing all pregnancies of women with and without beta-thalassemia minor was conducted. Deliveries occurred during the years 1988-2002 at Soroka University Medical Center. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with maternal beta-thalassemia minor. RESULTS: During the study period there were 159,195 deliveries, of which 261 (0.2%) occurred in patients with beta-thalassemia minor. The following conditions were significantly associated with beta-thalassemia minor: oligohydramnios (odds ratio [OR] 2.1; 95% confidence interval [CI] 1.2%, 3.7%), intrauterine growth restriction (IUGR; OR 2.4; 95% CI 1.4%, 4.2%), Jewish ethnicity (OR 1.5; 95% CI 1.2%, 1.9%), and previous cesarean delivery (OR 1.4; 95% CI 1.1%, 2.0%). No significant differences were noted between the groups regarding perinatal outcomes such as birth weight, low Apgar scores, congenital malformations, or perinatal mortality. Patients with beta-thalassemia minor were more likely to have cesarean deliveries than were the nonthalassemic parturients (16.9% and 12.2%, respectively; P =.021). However, while controlling for possible confounders such as IUGR, oligohydramnios, and previous cesarean delivery, with another multivariate analysis with cesarean delivery as the outcome variable, beta-thalassemia minor was not found as an independent risk factor for cesarean delivery (OR 1.3; 95% CI 0.9%, 1.9%). CONCLUSION: The course of pregnancy of patients with thalassemia minor, including perinatal outcomes, is favorable. Because higher rates of IUGR were found, we recommend ultrasound surveillance of fetal weight for early detection of IUGR. LEVEL OF EVIDENCE: II-2

PMID: 15172864 [PubMed - indexed for MEDLINE]

So the rate of C-section is slightly higher in thal minors, but thal minor was not considered to be the reason why.

Your Hb level is good for this point in your pregnancy. Hopefully, you have been taking folic acid throughout, as this helps to keep the Hb level up. If your pregnancy continues even free and your Hb level stays at a decent level, there is little likelihood you will need a C-section (at least based on anything to do with thal).
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Andy

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roxiana18
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« Reply #14 on: March 02, 2010, 02:27:10 AM »

Hello Andy

Thanks for the quick reply.I am based in India currently. My gynac has precribed me 50mg Iron. Earlier in my pregnancy I was asked to take folic acid after which when Iron was prescribed she asked me to stop taking folic acid. What do you say about that.

Regards
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