Hi

Just reading up on thal as it has been suggested as a possibility for my partner. He sees a haematologist next week so I expect further testing will confirm either way. My query is regarding iron levels. He has very low serum iron 2.8 (normal 9-30) and high ferritin 619 (normal up to 300). Hb, MCV, MCH, TIBC and transferrin are slighly low and there was a microcytic hypochromic anaemia. His platelet count was slightly high.

Are these readings likely to be indicative of thal? The iron reading has gone down in the last month and the ferritin has increased. If these readings are common in thal what treatment would be recommended?

Thanks!

Hi Pudding ,
 
WELCOME TO THE FAMILY PUDDING !!
stay connected i hope sharmin or other senior member will reply you soon .. soo please  wait .. And keep checking your post .. i hope everything will b O.K .... so stay cool  and relaxed...

take care
umair

Hello pudding, 

Welcome to our website.  Would you have your partners Hb and MCV values available to share with us?

The low iron levels can be the cause of lower hg - as suggested by the 'hypochromic' anemia - iron induced anemia.  The microcytic anemia may be suggestive of thalassemia minor/trait.  The iron levels are indeed low, your doctor can decide whether they need to be replaced.  Ferritin levels are usually not reliable in one test - rather it is a level that is tested over time.  Minor illness, such as the flu or even stress can cause elevated ferritin levels.  That being said 619 is quite a high level, it may be useful to repeat the test in about a month's time.  Was your partner sick at the time of, or prior to the blood test?

Thank you for posting Pudding and welcome to our website,

warm regards,

Sharmin

Thanks for the welcome!

The ferritin was high on two consecutive readings. Test 1 was followed by Test 2 a month later.

Readings are as follows:
           Test 1      Test 2     (Normal)
Iron      3.8      2.9          (9-30)
Transferrin      1.7      1.7   (2-3.7)
Total Iron Bind   39      39   (45-80)
Saturation      9.7      7.4   (16-60)
Ferritin      588      619   (30-300)
Hb      122      124      (130-180)
MCV      76      76   (80-97)
MCH      25      25   (27-32)
RCC      5      5   (4.5-6.5)
Plt       561      574   (150-450)

The red cells appear microcytic hypochromic with occassional target cells seen and moderate rouleaux formations. White cells appear normal.

His symptom is extreme tiredness, shortness of breath and some headaches.

Are these readings consistent with thal or not likely?
Thanks so much.

Pudding,
 
Your partner's results, from my experience, appear inconclusive as to whether he has thalassemia trait. 
Although the MCV level is low, it is a little higher than typically seen in thalassemia.  A protein electrophoresis would be useful
to determine if he has thalassemia. 

Uncomplicated iron deficiency can also present as in this way - with moderately severe iron deficiency - red blood cells are hypochromic and microcytic. 
These symptoms along with high ferritin, fatigue, and headaches can also be suggestive of inflammation or an autoimmune issue such as hypothyroidism or hemolytic anemia.  Because the rise in ferritin levels is not acute - a quick rise and drop - whatever the issue is (inflammation or infection) may still be present.  The hemotologist can also check for an enlarged spleen and other signs of infection. 

I wish I could conclusively tell you whether your partner has thalassemia or rule it out.  Can anyone else shed some light on these results?  Our resident expert, Andy, is away at a conference in Singapore.  Once he returns he may also help you with this issue.  In the meantime, I will try to do some research for you to see if I can get you some more information.  Please feel free to post any additional questions and we will do our best to help you. 

Please keep us posted - we wish you the best,

Sharmin

Hi Pudding,

Your iron studies are unusual and I am in Singapore and away from my home computer where I have the information to interpret the tests better. I do think a hemoglobin electrophoresis is absolutely necessary to rule out thal trait. I can't say from looking at the mcv and mch that I see an indication of thal trait. I shoud be able to tell you more when I am home.

Thanks so much. I really appreciate the assistance. I will report back after the haematologist next week.

Pudding,

We wish you all the best with the hematologist appointment.  Please let us know how it goes and if we can help with anything. 

Best,

Sharmin

I will be very surprised if thalassemia is implicated here. These particular readings of high serum ferritin and low serum iron point to anemia of chronic disease, rather than thal. The MCV and MCH are almost normal and usually we see lower with thal trait. Anemia of chronic disease is an adaptive response by the body to some condition in the body, often an immune response to systemic illness or inflammation.  The symptoms are similar to iron deficient anemia. In the case of systemic infection, the body will try to remove iron from where it is available to the infection by storing it in the serum ferritin, which will then test high while serum iron tests low because it has been moved to the ferritin where the infectious agent won't have access. Because of all this, the treatment is to treat the underlying condition and not the anemia, as the anemia will correct itself once the underlying problem is resolved.

Anemia of chronic disease is the typical conclusion when faced with low serum iron and high serum ferritin. If there is some known other condition such as a long term infection, immune system problem or inflammation of autoimmune origin, it can explain why your partner tests this way. The reason does need to be found so that it can be addressed. You can read more about Anemia of chronic disease at http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=263&channel_id=12&relation_id=1619

Symptoms of the anemia may include pale skin, lack of energy, fatigue, headache, laziness or lethargy, shortness of breath during exercise, and dizziness...
Accurate diagnosis depends on the results of blood test such as the following:

    * hemoglobin: low
    * reticulocyte count: low to normal
    * serum ferritin level: normal to elevated
    * serum iron: low
    * total iron binding capacity (TIBC): low

The following are examples of conditions that can cause anemia of chronic disease:

    * chronic infections (e.g., tuberculosis, lung abscess, and endocarditis)
    * autoimmune diseases or diseases with inflammation (e.g., rheumatoid arthritis, lupus, ulcerative colitis, Crohn's disease, giant cell [temporal] arteritis)
    * cancers (e.g., Hodgkin's disease, lung cancer, breast cancer)

This is quite a range and includes several serious problems. With the mild decrease in Hb I would be more inclined to think that this is related to something of an infectious or autoimmune nature. Of course, test results may return to normal if the problem runs its course and body corrects the anemia.

Thanks so much Andy. This is in fact exactly what the haematologist said yesterday. He indicated that he didnt think there was a thal trait at all and the doctor was wrong in surmising that there may have been. He is now doing more thorough tests to determine what is going on.

I thank you all for your welcome and advice and I wish you all the very best with your health.

Pudding,

Best wishes for you and your partner. Let's hope that the doctor can soon get to the bottom of the problem. I don't think treating the anemia will help, as the underlying condition needs to be determined and treated, and then the body should be able to resolve the anemia on its own.