Greetings, Dr. Roach I have thalassemia mild and am Greek. My iron content is very low, and my red blood cells are generally much smaller than normal. Each time I visit a new doctor and they do a blood test, they always stress that I need to take iron supplements since my iron levels are low.
I’m not sure if this is sensible advise because, as I understand it, thalassemia isn’t a problem with iron absorption from the diet, but rather a little red blood cell’s inability to store iron.
Will my iron levels rise if I use iron supplements? I worry about consuming more iron than my body can hold. Will the extra iron eventually be eliminated? I am aware that elevated iron levels are detrimental to general health. Just because I consume more iron doesn’t mean that my body will produce additional red blood cells to store iron as heme; instead, it will eliminate the extra iron.
What are my choices if iron supplements aren’t actually useful in preventing iron-deficit exhaustion during exercise? — P.L.
ANSWER: Thalassemia, which is derived from the Greek word for sea, is divided into two families. (In the Mediterranean, thalassemias are extremely prevalent.) Alpha and beta thalassemias are characterized by decreased or absent alpha and beta chains, respectively. There are two beta genes and four alpha genes, which means that there are many potential types of thalassemias.
You most likely have beta thalassemia minor, which is characterized by extremely small cells and mild anemia. It is caused by one normal gene and one that results in limited beta-cell-chain synthesis. This illness can resemble iron insufficiency quite a bit. Prior to administering iron therapy to patients, clinicians should confirm the diagnosis.
People with beta thalassemia minor will not benefit from iron at all unless they also have iron shortage. The smallest red blood cells observed in clinical practice are produced when thalassemia and iron deprivation are combined. Iron overload is not an issue for beta thalassemia minor in particular, but it can occur in other thalassemias. Therefore, some people may be harmed by receiving iron.
I anticipate that the additional iron in your situation won’t be absorbed by your body. Since the body cannot eliminate extra iron that has already been absorbed, chelation—the administration of medication to allow the body to expel iron—or bloodletting—phlebotomy—are the two main treatments for individuals with iron overload.
An individual in your role ought to have a thorough assessment of their iron reserves. It’s useful to compare your blood counts to your prior normal levels. It might be helpful to show this to new physicians because you most likely had a hemoglobin electrophoresis test performed at some point to diagnose beta thalassemia mild. A hematologist is the specialist in detecting thalassemias, and DNA testing is necessary to provide a conclusive diagnosis of beta thalassemia minor.
Because their anemia is so slight, most patients with thalassemia minor (alpha or beta) do not experience weariness as a result of it. I would worry that you have multiple issues if you feel exhausted after exercising. There are numerous reasons for fatigue, but a coexisting iron shortage may be the culprit. To help you deal with the exhaustion, you need a knowledgeable general practitioner.
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