Anemia: Should You Take Iron Supplements or Seek Further Testing?

Q: Anemia: Should You Take Iron Supplements or Seek Further Testing?

Dear Ms. Orange Cat： 1. Since you have questions regarding prenatal examinations, it is advisable to discuss them directly with your obstetrician-gynecologist. 2. Thalassemia, also known as Mediterranean anemia, is caused by a defect in the synthesis of globin c

Anemia-related

Hello Doctor, I recently underwent a pre-pregnancy health check, and my complete blood count showed several abnormal results highlighted in red.
The relevant values are as follows: WBC 5.9, RBC 4.22, Hemoglobin 9.0, Hematocrit 31.2, MCV 73.9, MCH 21.3, MCHC 28.8, Platelet 508, RDW-CV 15.8.
The obstetrician mentioned that I might have thalassemia (though did not specify the type) and advised me to take iron supplements for two months to see if there is any improvement.
However, I found information online stating that some types of thalassemia are not suitable for iron supplementation and could even lead to iron overload.
Should I start taking iron supplements now and have a follow-up blood test in two months, or should I get further testing done immediately to tailor the treatment? If I choose the former, I am already taking a multivitamin; should I still take the full dosage of the iron supplement as indicated on the packaging? If I opt for the latter, which specialty should I consult? Should I go directly to a hematologist? Thank you for your response.

Jú māo, 20~29 year old female. Ask Date: 2022/05/18

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Orange Cat:
1.
Since you have questions regarding prenatal examinations, it is advisable to discuss them directly with your obstetrician-gynecologist.
2.
Thalassemia, also known as Mediterranean anemia, is caused by a defect in the synthesis of globin chains in hemoglobin.
Among them, alpha thalassemia involves a defect in the synthesis of the alpha chain and is more common in Taiwan, with the genetic mutation located on chromosome 16.
Generally, hemoglobin electrophoresis can be used to rule out the possibility of beta thalassemia or genetic testing can be performed for diagnosis.
Beta thalassemia, on the other hand, involves a defect in the synthesis of the beta chain and has more clinical significance; its genetic mutation is located on chromosome 11 and is an autosomal recessive disorder.
Blood tests for hemoglobin electrophoresis are typically required for confirmation.
In both alpha and beta thalassemia, microcytic anemia with compensatory increased red blood cell count can be observed; this is why clinicians can often diagnose thalassemia based on a hematology report.
3.
Iron deficiency anemia is the most common type of anemia, caused by factors such as insufficient dietary iron, impaired iron absorption, increased iron requirements, and chronic blood loss.
Since iron is a crucial component of heme, which is a major component of hemoglobin, a lack of iron can affect hemoglobin production, leading to iron deficiency anemia.
Patients with iron deficiency anemia typically present with microcytic anemia and low hemoglobin levels.
The ferritin concentration in the blood (a protein that binds iron) decreases, usually below 30 ng/L, while transferrin saturation (a protein that carries and transports iron) is generally less than 20%.
Both iron deficiency anemia and thalassemia are classified as microcytic anemias; however, the differentiation lies in the fact that iron deficiency anemia shows less compensatory increase in red blood cell count compared to thalassemia.
4.
In our country, the prevalence of thalassemia carriers and iron deficiency anemia is relatively high, and both conditions often occur concurrently.
On the other hand, many individuals may not pay attention to anemia or may be unaware that they have it, leading to a lack of sufficient information when clinicians or obstetricians first encounter patients with anemia.
Therefore, there can be practical difficulties in the differential diagnosis of anemia.
The management by your obstetrician-gynecologist is reasonable!

Reply Date: 2022/05/18

More Info

When it comes to understanding anemia, particularly in the context of your recent blood test results, it's crucial to approach the situation with a comprehensive understanding of the underlying causes and appropriate management strategies. Your blood test results indicate a low hemoglobin level (9.0 g/dL), low hematocrit (31.2%), and low mean corpuscular volume (MCV) (73.9 fL), which suggest microcytic anemia. This type of anemia can be caused by several factors, including iron deficiency, thalassemia (a form of Mediterranean anemia), or chronic disease.

Given that your obstetrician has suggested the possibility of thalassemia, it is essential to clarify the type of thalassemia you may have. Not all types of thalassemia are treated the same way; for instance, individuals with beta-thalassemia trait may not require iron supplementation, while those with iron deficiency anemia would benefit from it. Therefore, taking iron supplements without confirming the type of anemia could lead to complications, including iron overload, especially if you have a thalassemia trait.

Recommendations:
1. Further Testing: Before starting iron supplements, it would be prudent to undergo further testing to confirm the type of anemia you have. This may include:
- Hemoglobin electrophoresis: This test can help determine if you have thalassemia or other hemoglobinopathies.

- Iron studies: These tests measure serum iron, ferritin, total iron-binding capacity (TIBC), and transferrin saturation to assess your iron status accurately.

2. Consultation with a Specialist: If you suspect thalassemia or if your doctor has indicated this possibility, it would be wise to consult a hematologist. They specialize in blood disorders and can provide a more accurate diagnosis and tailored treatment plan.

3. Iron Supplementation: If your further tests confirm that you have iron deficiency anemia, then starting iron supplements as recommended by your doctor would be appropriate. If you are already taking a multivitamin that contains iron, you should check the dosage to ensure it meets the recommended daily allowance without exceeding it. Generally, the typical dose for iron supplementation is around 100-200 mg of elemental iron per day, but this should be tailored based on your specific needs and blood test results.

4. Monitoring: If you do start iron supplements, it is important to have follow-up blood tests after about 2 months to assess your hemoglobin levels and overall response to the treatment. This will help determine if the iron supplementation is effective or if further intervention is needed.

5. Dietary Considerations: In addition to supplements, consider dietary sources of iron, such as red meat, poultry, fish, lentils, beans, and fortified cereals. Pairing these with vitamin C-rich foods can enhance iron absorption.

Conclusion:
In summary, while your doctor has suggested iron supplementation, it is crucial to confirm the type of anemia you have through further testing before starting any treatment. Consulting with a hematologist would provide you with the best course of action tailored to your specific condition. Taking iron supplements without proper diagnosis could lead to unnecessary complications, so it's best to proceed with caution and ensure you have a clear understanding of your health status.

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