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Forum Name: Hematology Topics

Question: Chronic low MCV, MCH, finally investigated - now questions


 kconner - Sat Aug 11, 2007 2:54 pm

My daughter (now 18) has a chronic but 'benign' history of health issues:
asthma in infancy - recurrent pneumonia
antibiotic and environmental allergies
ears and sinus surgeries (10)
non-ossifying fibroma - surgically repaired
Spondyloarthropathy
pre-diabetic
borderline obesity
intermittent positive ANA
thyroid antibody present/elevated

At about age 9, I began to notice her blood results showing mildly low MCV, MCH, MCHC with no other anomalies. I was told it was nothing.. A few years later with the same results - I was told to try iron therapy - we did this with no result.

She has just had her first adult physical in preparation for college - she was told to see her ob/gyn for heavy periods due to anemia (form letter) - I called to let the nurse/doctor know that she barely had periods and in fact we'd put her on the pill at age 14 to finally attempt to regulate what little she had.

We were referred to hematology and there we were told that she was a carrier of Thalassemia. but then called and told to give her 325mg of iron 2x/day. no other information, followup etc.

Here results from hematology were:
hemoglobinopathy profile = hgb A increase
TIBC= increase (478)
UIBC= increase (453)
serum iron = decrease (25)
iron saturation = decrease (5%)
ferritin = decrease (5)

Her family history does include blood disorders polycythemia, polyschemia vera, diabetes, heart and vascular disease, hashimoto.

A followup was not recommended - a diagnosis not given. Should I assume she is simply low on iron and have her take it as recommended (even though this same therapy did not work before)? Should I have her revisit her Endocrinologist? Is there anything else I should do or should I feel comfortable sending her away to college with only "take iron" as our instruction? Is she still considered a carrier of Thalassemia and should we pursue anything there?

She was treated with chloramphenicol as a baby for pneumonia. could this contribute?

After so many years of having blood results missed (ANA x 2 years) and even her fibroma was missed after years of reported pain - I am nervous at the lack of explanation here.

What would you do?

Thank you in advance for your consideration!!
 kconner - Sat Aug 11, 2007 2:59 pm

so sorry.. one follow-on note that I doubt to be related but felt I should include.

family history of cancers is significant on her maternal side = (paternal grandfather line).. every single sibling experienced or was taken by cancer - these include:
lymphoma x 3
leukemia (CLL)
lung x 5
multiple myeloma

cousins are now being affected (lymphoma) -
 Dr. Chan Lowe - Sat Aug 11, 2007 3:35 pm

User avatar Hi Kconner,

It may be that your daughter has thalassemia and iron deficiency at the same time.

Her iron tests do indicate that her iron levels are low.

To formally diagnose thalassemia, hemoglobin electrophoresis is done. I suspect this has been done since you state she has elevated HgG A. There are two types of HgB A (A1 and A2). If it is the A2 form that is elevated it would be consistent with thalassemia minor.

Beta thalassemia minor typically will produce increases of HgB A2 in the range of 4-5%. It is typically asymptomatic and an incidental finding.

If the iron deficiency is not improved by taking iron supplements there may be a problem with iron absorption. I would recommend her iron studies be repeated after 6 weeks of therapeutic iron dosing (not just taking a multivitamin with iron as this often does not have enough iron in it to correct deficiency).

If proper iron dosing does not correct the issue she should have an evaluation for absorption problems such as Crohn's disease or Celiac disease.

Best wishes.
 kconner - Sat Aug 11, 2007 3:46 pm

Thanking you SO much!! It's tough enough to send them off on their way without this hanging over her head!

You are right.. the rest of the hemoglobin profile was normal including the Hgb A2.

I did not see that a smear of any kind was done - don't know that this is important.

I appreciate your response more than you know!
Have a blessed day!
 Dr. Chan Lowe - Wed Aug 15, 2007 1:23 am

User avatar Doing a blood smear may or may not be helpful. Iron deficient cells have a characteristic pale, small look to them. Thalassemia cells tend to all be small and look the same.

Other testing can often give the same results so a smear is not necessarily crucial but can give some good information.

I'm glad you find our site helpful. Please feel free to visit again if you need.

Best wishes.
 ma_girl - Thu Sep 20, 2007 3:46 pm

Hello kconner,

If she is a Thalassemia(Carrier), you might want to make sure about it before she plans for marriage and/or a child. Also, there might be other siblings of her who are Thalassemia(Carrier).

For her to be a Thalassemia(Carrier), either of her biological parents would carry a Thal gene which was passed on to her. She should follow up with a Thalassemia specialist and should note that she needs to take care of herself(especially when she is pregnant as Thal might affect her pregnancy). If her partner is also a Thal(Carrier) and if she is confirmed a Thal(carrier), their chances of having a Thalassemia(Major) child is 25% and the child will not make his or her own blood. So, be aware of Thalassemia and try to find out her status before hand

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