Hemoglobin and red cell sudden drop, need help

Hi, glad to find you guys. I'm 38 male from CA, just recently found out I'm a alpha thal with 2 gene deletion through DNA testing. My hemoglobin was between 13 to 14 and red cell is 6.3 to 7.0 for the last 5 years looking back to dozen of my lab record. Just recently start taking centrum silver multi, 400mcg folic acid, 250mg milk thistle, 1300mg fish oil called omega factor 3, and 4 ounce aloe vera gel daily. I started taking this for about a month after I discover that I'm a thal hope to bring the hemoglobin level up. I did the lab couple days ago for my pregallbladder surgery. My hemoglobin was 11.9 low, my red cell is 5.7 normal, white cell 7.0 normal, hematocrit 37.7 low, mcv 65 low, mch 20.6 low, mchc 31.6 normal low, Neutrophil % 44 low, Lymphocyte % 48 high. I'm surprise why my hemoglobin and red cell drop all a sudden within a month is it the vitamins I take or is there cancer forming that is causing it? Real frustrated because surgery is next week. I never have hemoglobin and red cell this low for all this years until I found out about thal, now to think back that is why I have all this health problem. Just to mention a few I have asthma, heart pal., fatty liver recently discovered , gall stone, you name it I have most of them. Thanks for reading.

Hi Dc,

Sudden hemolysis in alpha thals is thought to be related to the more severe variety, HbH disease. However, we have heard from other alpha minors about episodes of sudden hemolysis. This is known to be the result of exposure to certain drugs, chemical fumes and broad beans, specifically fava beans. There is a partial list at http://www.thalassemiapatientsandfriends.com/index.php/topic,3410.0.html

Various chemical fumes may be implicated, including dryer fabric softener sheets. Your Hb is usually in the normal range, which is expected with alpha trait. It seems unlikely that the drop in Hb was related to the supplements. They are all fairly benign in terms of side effects. I believe that Centrum Silver does not contain iron, so unless there was a reaction to the coloring in the vitamins, it doesn't seem like that should be a problem either. Keeping a diary of foods eaten, medications used and exposure to chemical fumes as common as moth balls and then seeing if there are any possible hemolysis triggers might help you find if there are things you need to avoid. Try to avoid any vitamins and supplements that aren't natural source and watch for any connection between eating beans or legumes and drops in Hb.

The drop in the red cell count is actually towards the normal level, so that is no concern. The previous higher level could likely have been in response to the hemolysis, as your bone marrow became more active in order to replace the red blood cells lost to hemolysis. The gallstones indicate that there has been hemolysis over the long term. Your other symptoms also suggest that you are a somewhat symptomatic alpha minor, although that is considered to be an asymptomatic condition. Because of this, it is difficult to get doctors to listen to the possibility that symptoms are related to thal. Thal minors have an ongoing state of hemolysis to some extent, as defective red cells are removed. This can lead to gallstones over time, along with some enlargement of the spleen. A sudden drop in Hb in alpha thal is most likely due to some exposure, although stress is also a possibility. There is nothing in the test results you have provided to lead to any suspicion of cancer.

Thanks a ton for your time and effort on this site Andy. Centrum silver have 18mg of iron but I don't think is the cause. I have high level of stress and anxiety my whole life, even more stress finding out that I have thal do you think stress can cause hemolysis. What I'm afraid is that somehow it can turn to hbh disease.  Thanks for your response Andy.

Unless you have a history of iron deficiency, it would be best to avoid iron supplements. Iron is contraindicated in alpha thalassemia. There is a Centrum without iron that many thals use. Your can't change from alpha trait to HbH, but you may experience incidents of hemolysis that last up to 2 weeks.  By observation, you may be able to find what sets it off.

Thank you, Andy.

Without you we and the world would never know much about thal. 

DC - Ditto!