How to manage low hemoglobin levels during pregnancy?

Question

Hello doctor,

I am a 29-year-old pregnant woman at 19 weeks gestation. My complete blood count (CBC) results indicate that I have microcytic hypochromic anemia with a hemoglobin (Hb) level of 8.4 g/dL. My serum iron levels are normal, but my serum ferritin levels are slightly elevated. Additionally, my reticulocyte count is 4.5 percent. I have no organ enlargement or jaundice.

Upon conducting Hb electrophoresis, the results showed HbA2 at 5.5 percent and HbF at 1.1 percent. I am wondering if this indicates a case of thalassemia trait. Currently, I am taking multivitamins, omega-3, iron, and calcium tablets for my pregnancy.

Could you please provide your recommendations and suggest treatment options for managing low Hb levels during pregnancy?
Should I consider receiving a red blood cell transfusion?

Thank you in advance for your assistance.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concerns.

Based on the provided history, the electrophoresis results showing elevated HbA2 (Hemoglobin A2) levels suggest the possibility of thalassemia minor. Typically, such cases present with microcytic hypochromic red blood cells (smaller and paler than normal), which supports this diagnosis. To confirm further, it is recommended to check the RBC (red blood cell) indices and calculate the Mentzer index. Thalassemia patients usually have a Mentzer index below 13.

In your case, since your hemoglobin level is low, taking iron tablets should be sufficient. However, it is important to be cautious, as elevated ferritin levels in thalassemia indicate increased iron storage in the blood. At this point, there is no immediate need for a blood transfusion. If the severity of anemia worsens, then injectable iron or a blood transfusion may be necessary.

Considering your thalassemia status, it is also advisable to check your partner's test results. If he is also a carrier of thalassemia, further investigations such as amniocentesis may be required to rule out thalassemia major in the fetus.

In light of these considerations, it is recommended to follow the advice of your treating gynecologist and continue taking the prescribed elemental iron tablets.

I hope your concerns are resolved.

Please let me know if I can assist you further.

Thank you.