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Question

Dear Dr,

My wife (28) is a "Beta-ThalessemiaMinor" patient, and I am normal (28). We are planning our first child. Due to the associated high cost of IVF and Genetic screening procedures we decided to go ahead with normal delivery though there is a 50% risk of becoming my child a Beta-Thalessemia Minor patient (carrier). However, I would like to know about any complications and precautions that I should take on behalf of my wife as we are planning for a normal birth? I would be very much grateful to you if you can give some guidelines (precautions) that we should adhere in each stage of pregnancy? Thank you in advance,
Yours faithfully.
Ruwan.

Submitted: 266 days and 23 hours ago.
Category: Health
Value: $14
Status: CLOSED
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Posted by Schuyler_ANP 266 days and 21 hours ago.

Answer

Hello,

 

Welcome to Just Answer and thanks for your question. I'm a little confused by your terminology in calling your wife a beta thalassemia minor patient. Are you saying that your wife has beta thalasemia minor (trait)? That is one normal beta copy and one abnormal? In that case there is a 50% chance that a child would also have beta thalassemia minor (trait) and 50% would not. The odds are the same no matter how many children you would have. Since beta thalassemia trait usually has no symptoms, you really do not need to do anything special for your wife at any stage of her pregnancy. Her health care providers will be monitoring her blood to make sure she doesn't become anemic, since mild anemia is about the only symptom people with the trait have.

 

266 days and 13 hours ago.

Reply

Thank you very much for answering my question. Yes, you are correct. she is Beta-Thalessimia Minor (Trait).
I have been reading a lot on this issue.. and really worried about blood clotting disorders etc that are related with beta-thal. carriers. It would be great if you can read some of the following artcles and explain me what sort of precaustions should I take to avoid any difficulties or serious situations as explained in the following articles. I found the explanations (given in the link) are too technical so that it is difficult to understand. That's why I was expecting some sort of guidelins to follow in each stage of pregnancy (ie. first trimester, second and third?). Thank you very much again, hoping a good explanation this time.

http://www.thalassemiapatientsandfriends.com/index.php?topic=1399.0;highlight=hypercoagulable
http://www.thalassemiapatientsandfriends.com/index.php?topic=109.0;highlight=hypercoagulable
http://www.thalassemiapatientsandfriends.com/index.php?topic=1736.0
http://bloodjournal.hematologylibrary.org/cgi/content/full/99/1/36

Thank you again

Accepted Answer

Hello,

 

I have spent a GREAT deal of time reading these comments, and the links within the links within the links. No doubt you have spent a lot of time online as well trying to find out more abut your wife's condition. However, blogs and patient-to-patient forums are not necessarily the place to do it with the best success, since misinformation abounds.

 

In the first one, for instance, the patient's problems were not related to her thalassemia minor, but to another congenital (inherited) condition called thrombophilia that caused the hypercoagulability state. This is a completely separate entity, just as blue eyes and brown hair are separate entities that are not dependent on the same genes, or as another example from the genetic disease spectrum, someone can inherit both sickle cell disease (an anemia disorder) and Duchenne muscular dystrophy (a neuromuscular disorder). The patient's difficulties were related to the thrombophilia, not her thalassemia minor.

 

In the second article, the administrator cites a 2002 article in Blood Journal as his reason for assuming that people with thalassemia minor have a hypercoagulability as part of their carrier state. However, when you read the article, it doesn't even look at minor. It is totally concerned with thalassemia major and intermedia, and both alpha and beta thalassemia. He is comparing apples and oranges.

 

Another article mentions the patient is being evaluated for MTHFR or methylenetetrahydrofolate reductase disorder which is another genetic problem that prevents normal use of B vitamins and folate. Your wife's doctors will probably be testing for this. It is a cause of repeated miscarriages. It is another cause of hypercoagulability.

 

Your wife's ob/gyn will be monitoring her blood, blood pressure and other factors regularly and monitoring the growth of the baby to check for IUGR (intra-uterine growth restriction) and just generally checking the overall health of the pregnancy from month to month and then week to week. Any abnormalities will be conveyed to you.

 

I would suggest you forget all you've read on that particular site, and ask your wife's obstetrician who has run all the tests if there are any particular precautions to take. When her blood tests are normal and she is taking all the appropriate vitamins and supplements, eating a healthy diet, maintaining a healthy weight, and getting her exercise and fluids, there are really no other specific things to do absent blood tests to the contrary, and we cannot do them online. The only one who can give you specific recommendations pertinent to any particular pregnancy is the ob/gyn and hematologist who are overseeing that person's gestation. The agree, above, comes from Dr. Douglas, an ob/gyn. As you can see from the following article, outcomes for women with beta thalassemia minor and their babies is comparable to those of women who do not have the trait, but monitoring for IUGR is suggested. Of course monitoring the fetus for normal growth is the standard of care for all pregnancies.

 

http://www.ncbi.nlm.nih.gov/pubmed/15172864

 

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Expert: Schuyler_ANP
Pos. Feedback: 99.5 %
Accepts: 8824
Answered: 6/21/2009

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Board Certified Nurse Practitioner, MS, RN. Private practice and hospitalist experience.

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