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Thalassemia Patients and Friends and thalpal Ā© A. Battaglia 2018





54763 Posts in 5806 Topics by 6042 Members
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This is Thalassemia Patients and Friends,
dedicated to its founder,
Lisa Cammilleri.
(1970-2004)
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Author Topic: " Normal variation " or alpha thalassemia trait? A doctor is asking...  (Read 453 times)
Amyntas
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« on: August 10, 2018, 05:50:05 PM »

Hello, I am finishing my residency in cardiology in Greece and a routine blood test showed very low folic and b12 ( first time checked). What I knew from old tests,  was that I used to have a mild microcytosis and a little elevated bilirubin (Gilbert syndrome), near normal As I was said, but without iron deficiency.
After that I had full blood test,  and check for b12 deficiency without anything else it is worth mentioning.
  Even if it isn't such a severe disease,  I have some symptoms to mention : I get pale very easily, especially after tiredness or stress even if I feel well. Is it possible that an alpha thalassemia trait could have caused this situation? And what should I do?
B12: 145,  folic: 2.8 (3-20), LDH 197(normal), HbA2: 2.5, normal electrophoresis, negative celiac antibodies, the rest on images.
Thank you for your time...
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Andy Battaglia
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« Reply #1 on: August 18, 2018, 03:02:04 PM »

Yes, alpha trait can cause these issues. Your MCV is low enough and your RBC is high enough to suspect some type of thal and with the normal HbA2 level, it would't be beta thal. DNA analysis would be needed to confirm alpha trait.
The problem seems to stem form the low B-12 and low folate levels, and this is likely related to being a thal carrier, as the overactive bone marrow depletes nutrients needed to manufacture red blood cells. Your B-12 is very low and it is best to be near the high end of normal when you carry thal, >800. I would recommend a 2500 mcg sublingual B-12 tablet taken daily, and for the time being, 5 mg L-methylfolate daily. Was your vitamin D level also checked? This can often be part of the problem.
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Andy

All we are saying is give thals a chance.
Amyntas
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« Reply #2 on: August 19, 2018, 05:57:16 AM »

Thank you for your valid answer. I will look for a dna analysis.  Your question is accurate : I also had low vitamin d , near the low end of normal. I have already taken b12 , folic as you said and cod oil for vitamin d and feel more active . In thal trait, Do you think there is need for the rest b complex too? And what would be a usual daily intake of these vitamins, after normalization?
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Andy Battaglia
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« Reply #3 on: August 25, 2018, 01:54:42 PM »

I have found that most symptomatic thal minors do better when they continue sublingual B-12 and L-methylfolate long term. I would not recommend stopping if your levels get to an acceptable level. A B complex tablet can be of help, and even though I am not thal minor, I find if I don't take the B complex, it does adversely affect me. It happened just this week when I had to rush off to work without time to take any supplements. The fatigue that day was terrible. I take vitamin D once weekly and after years of daily doses of 5000 IU, I switched to once weekly doses of 50,000 IU and have found that is the best approach to correcting vitamin D, just as the eminent Dr Eliot Vichinsky has found with thal majors.

As far as dosing, I generally suggest 1-5 mg L-methylfolate daily for thal minors, although a couple minors have told me that doses of 10 mg daily have done wonders for them. Sublingual B-12 can be taken in doses of 1000-2500 mcg daily. Sometimes, you have to experiment to find what works for you. Magnesium and L-carnitine play an important role in the production and health of red blood cells.
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Andy

All we are saying is give thals a chance.
Amyntas
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« Reply #4 on: August 29, 2018, 11:40:00 AM »

Thank you for your detailed answer. You covered every aspect of my question. 
Keep on with the scientific work .
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