Help with Understanding Test Results

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Offline iThinkMedia

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Help with Understanding Test Results
« on: October 05, 2011, 04:42:43 AM »
Hello as I've said in my previous post I just found out today that I have Thalassemia.
Can someone help me understand the following results:

RBC 4.1
Hemoglobin 8.4
Hematocrit 29.2
MCV 71.7
MCH 20.6
RDW 21.5
Hemoglobin A 97.9
Hemoglobin A2 (QUANT) 2.1

Interpretation
Microcytosis is present suggesting possible iron deficiency or thalassemia. (Note I am not iron deficient - in fact am a bit high in iron)

Thanks in advance for your feedback and thoughts on this issue.


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Offline Andy Battaglia

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Re: Help with Understanding Test Results
« Reply #1 on: October 05, 2011, 05:53:48 AM »
Hi Vanessa,

Were you told if it was alpha or beta thalassemia minor? The normal HbA2 level and absence of HbF in the electrophoresis, along with low MCV and MCH would point more to alpha than beta minor. Beta minor would normally have an HbA2 around 5 or higher and some measurable HbF. Do you know if your hemoglobin level has chronically been below 9? Are your iron levels high from supplementing trying to boost your Hb level?
Andy

All we are saying is give thals a chance.

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Offline iThinkMedia

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Re: Help with Understanding Test Results
« Reply #2 on: October 05, 2011, 03:14:52 PM »
I've not been told I have either yet because my doctor has limited knowledge of the topic. I am so confused and stunned because this is the first time I've learned of this so I'm just stumbling through so your help and information is nice.

What is the difference between alpha and beta? I had a CBC test done and yes my hemoglobin is 8.4 and my iron serum levels are high at 237 because I had been supplementing because I felt so tired.

Note on my CBC test comments include:
Teardrop cells observed
RBC fragments observed

I also read it is possible to acquire this disorder later in life without it being genetic. http://bloodjournal.hematologylibrary.org/content/105/2/443.long
I scanned the document but of course don't really understand it all.


« Last Edit: October 05, 2011, 03:38:40 PM by iThinkMedia »

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Offline Andy Battaglia

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Re: Help with Understanding Test Results
« Reply #3 on: October 06, 2011, 03:27:36 AM »
Vanessa,

Is your anemia long term or is it a recent development? Have you battled tiredness and fatigue throughout life? The acquired form of α-thalassemia is the result of a hematologic malignancy and would appear with no prior history, although with alpha thal there can also be sudden drops in Hb level as a result of exposure to certain drugs, chemicals or fumes, and even fava beans, so a sudden drop doesn't necessarily mean a malignancy is present.

Hemoglobin is made from equal parts alpha globin and beta globin. There are 4 total alpha globin genes on the two chromosome 16 and 2 beta globin genes on chromosome 11. If one or more alpha genes is deleted or mutated, some form of thalassemia will be present from carrier status to major. If one beta gene is missing or mutated, beta minor is the status. If both are missing or mutated, it results in thal major. Because the total hemoglobin produced is affected, beta minors and two gene affected alpha thals will often have a lower than normal hemoglobin. So, if you do carry thal, the low hemoglobin level would be an ongoing problem.

I think a visit to a hematologist would help. I can't say that all the indices you've provided point to any one thing in particular, but the absence of any HbF in the electrophoresis seems to make beta minor unlikely, but if the lab has no experience with thal testing, they may misread the test. I think a hematologist would order a new set of tests for comparison and also weigh the significance of the physical characteristics of the red blood cells, as they are seen with thalassemia, but not exclusively.
Andy

All we are saying is give thals a chance.

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Offline iThinkMedia

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Re: Help with Understanding Test Results
« Reply #4 on: October 06, 2011, 03:57:02 AM »
The anemia has been going on for several years but I always thought it was an iron deficiency. A few weeks ago I had a dizzy spell that scared me enough that I almost called 911. But instead I recovered, called my doctor the next day and they did a blood workup which is when they discovered the possibility of thalassemia because I was anemic but not due to an iron deficiency.

As I look back I've battled being tired all my life -- but I was raised to just deal with it, no time to be tired! But as I've gotten older it seems to have gotten worse especially since I've been fighting anemia for several years. I also moved to a higher altitude about six years ago which could be a contributing factor because before this I've always lived at sea level.

In addition in the past when I've worked from home I was able to take naps and sleep in so I didn't notice it as much.

My biggest concern is I have no insurance so I pay for all tests and doctor visits out of my pocket. So money is always an issue and if I can control this with diet/vitamins etc then that would be the best route.

My symptoms have been dizziness, tiredness, cold hands/feet (all my life), a heart arrhythmia (all my life), recently the mind fuzziness has come into play and was more pronounced when I was taking extra iron. However, since I stopped taking iron I'm not experiencing the mind fuzziness as much and have much more energy.

I started taking folic acid today and several other supplements. It is amazing my energy has slowly come back and I don't tire as easily -- before I would walk up a half flight of stairs in my house and I would have to stop and rest.

I appreciate all the information the forums have provided and continue to do my research. If I can get the dizziness and tiredness to go away then I'll be golden -- I've lived with all the other symptoms my entire life just never attributed them to anything.

« Last Edit: October 06, 2011, 04:55:33 AM by iThinkMedia »

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Offline Andy Battaglia

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Re: Help with Understanding Test Results
« Reply #5 on: October 08, 2011, 03:10:31 AM »
Hi Vanessa,

The symptoms you describe are typically reported by thal minors here. As I mentioned, the blood tests look more like alpha than beta thal. but I can't be certain. When you go to a higher altitude there is less oxygen in the air, so there is a real difference. After a few weeks at that altitude, the body will compensate by producing more hemoglobin to carry more oxygen. This will normally raise the Hb level of beta minors, but I have never seen any info on the effect on alpha. If you are alpha, it does mean you won't get any Hb boost from HbF so that may be a factor. The zero fetal hemoglobin reported in your electrophoresis does tend to make me think alpha as do the MCV and MCH which are dead on for alpha trait (minor). As minors get older they do report more problems with tiredness and fatigue, along with numbness in the extremities, feeling cold all the time, and the irregular heart beats. If it alpha thal, there is an added danger. Certain beans like fava beans, but in some people other beans and legumes are also at fault, and chemical fumes and certain drugs can cause hemolysis which lowers the Hb level. I suggest minimum exposure to chemical fumes, like avoiding gasoline vapors at the pump, zero exposure to mothballs and even watch for things like fabric softener dryer sheets, as these have also been reported as causing hemolysis. If you suddenly feel much more tired than you had been, review what you've eaten and if you may have taken any over the counter meds or had some exposure to chemical fumes.

Folic acid is the only recommended treatment for alpha thal, and it is also recommended for beta thals. I suggest B complex, vitamin E and magnesium because these are all essential for red blood cell formation and RBC health. Many women already take calcium to help prevent bone loss as they age, but it's best to take a calcium/magnesium with vitamin D supplement. If you don't get regular exposure to the sun, vitamin D can also be low adding to the tiredness. It is probably the most common vitamin deficiency in northern climates. Calcium and magnesium control the two sides of a heart beat and are needed in balance. Sometimes taking a supplement can help reduce the irregular heart beats. Magnesium is also important for the health of the RBCs, as it keeps the cell walls stronger, enabling them to survive longer. Hemolysis is a regular feature of thal minor and the effects are completely overlooked by doctors, but in reality minimizing hemolysis will make a healthier individual, because their bodies have a better oxygen supply but also don't have to deal with the by-products of the hemolysis. Providing proper nutrients also helps create better RBCs in the first place, which means fewer of the small weak RBCs seen in your blood smear. Since you don't have insurance, tests to determine exactly what type of thal it is will prove too costly, and it won't really have much affect on how you will proceed. The best thing you can do for yourself is to eat well, get plenty of vitamins, minerals and antioxidants in your diet and take a few supplements. Exercise as much as you can even if it's mild exercise like a short walk. I do suspect the high altitude does have something to do with the lower Hb, as you are not compensating much if at all for the thinner air. The one thing that really bothers me is the no insurance. We need public health insurance in this country like they have in Europe so people can get proper medical care. Working with this group for so many years has exposed me to much about the rest of the world and as far as developed countries, the US really lags in some areas. And the health care plan passed in the US is going to do little to remedy any of this. Anyway, I do empathize and want to help if I can, so if you have more questions or concerns, please continue to post. With the cost of insurance, prescriptions and co-pays, I think we're going to see a lot more people without insurance regardless of any government mandates. If the government wants to do something, they should have Medicare cover everyone and get it over with. The current system of never ending price increases is not sustainable in the long term.

And as a group, I hope minors will share everything they learn about what helps them feel better. I don't see much help coming from the medical profession for thal minors, so minors are going to help each other out.
Andy

All we are saying is give thals a chance.

 

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