Anemia without low iron

Catherine,

It does not look like beta thal trait, but does not rule out the possibility of alpha trait. If iron does not raise the HB, the suggestion in the report is a DNA analysis after 6 months of iron if iron does not solve the problem. This doesn't mean there is a likelihood of alpha trait, but it shows that iron deficiency and alpha trait give very similar test results.

Hi Everyone

My daughter has been taking iron tablets due to iron deficiency anemia for the last two months.

Her doctor has adviced me verbally that her hemoglobin has dropped to 91 (from 106).

Should I  worry?  Is this still mild anemia?   We see the doctor again on Monday.

Regards

Catherine

Hi Andy

These are Sarah's latest test results:

Haemoglobin 91 *
Hct 0.29 *
RBC 3.9
MCV 74 *
MCH 24 *
MCHC 320
RDW 16.5
Platelets 298
White Cells 5.9
Neutrophils 4.3
Lymphocytes 1.0 *
Monocytes 0.4
Eosinophils 0.2
Basophils 0.0

S Iron 2 *
S TRF 2.1
S TRF SAT 4*
S FERRITIN 71

The only result that has gone up after 2 months of iron tablets is S Ferrtin.

Does this still look like iron deficiency anemia?  


* These are marked with "L"

Thanks for your assistance.

Catherine

Catherine,

Yes the low iron numbers do look like iron deficiency. The ferritin has risen but the other numbers are still below normal. In the long run, iron rich foods may be more effective than iron tablets. Diet is the factor that can be controlled but can be especially difficult with teens because of schedules and also food choices. Short term, some doctors will prescribe IV iron to try to get the levels up to normal.  As is typical, alpha thal trait cannot be ruled out without a DNA test so its involvement could have a slim possibility, but it shouldn't affect tested iron levels, so it does look like deficiency.

Thanks for your advise

At least I know she is taking the iron tables.  Although the anemia has lot worse, overall she feels the best she has in months.

We will see whatt the blood tests show in two months.  We eat meat every day so can't add anymore meat to the diet but will try to add more leaf greens.

Catherine

Hi Everyone

My daughter has now has a diagnosis with Irritable Bowel Sydndrome with Iron deficiency anemia.
They believe these are both diet relatived.  She is now missing on average one day of school per week.

We are about to start food testing.

Is there any reason to avoid broad beans (fava beans), I can see from this site they are a problem for some people.

Regards
Catherine

Hi Catherine,

Fava beans can cause favism leading to hemolysis in alpha thals, resulting in a sudden drop in hemoglobin level. There are reported cases of beta thals also having favism. However, non-thals can also have favism, as this relates to G6PD Deficiency. Everyone with Favism is G6PD Deficient but not all with G6PD Deficiency have favism.

http://g6pddeficiency.org/index.php

G6PD Deficiency, a disorder involving the X-chromosome, was once thought to be symptomatic only in men. G6PD Deficiency is now known to be slightly more common in women than men though the symptoms are generally not as severe unless both X-chromosomes are affected.

Other beans and legumes, such as soy are also implicated in favism in some people. If favism is suspected there are tests to determine if it is present. It is especially prevalent in those of Mediterranean origin and has been noted to have a high rate if incidence in Australia among people of this origin because fava beans are a common food in Australia. In people with severe favism, the pollen of the fava plant can cause severe hemolysis and even death.

The diagnosis of G6PD deficiency is made by a quantitative spectrophotometric analysis or, more commonly, by a rapid fluorescent spot test detecting the generation of NADPH from NADP. The test is positive if the blood spot fails to fluoresce under ultraviolet light. In field research, where quick screening of a large number of patients is needed, other tests have been used, however, they require definitive testing to confirm an abnormal result. Tests based on polymerase chain reaction detect specific mutations and are used for population screening, family studies, or prenatal diagnosis.

If broad beans are part of the diet, it would be easy enough to exclude them for awhile to see if the Hb rises. If it does, testing for G6PD deficiency should be considered.

Thanks for your reply, Andy.

Won't give her anymore broad beans, not worth the risk no matter how small.

We have had major change of diet over the last couple of weeks as Sarah has tested positve for lactose intolence and boardline fructose malabsorption.  This has required the removing of wheat, rye, lactose, onion, garlic, apple, pear plus a number of other things from her diet. 

Catherine

I am sad to hear about food intolerance. Must be difficult. Have you notice any changes since her diet changed?

Hi,

I think i mentioned this on another thread, but iron supplements caused my Irritable bowels. I went on a gluten free diet for 3 years, and am back on a normal diet now. I cant digest Fats, I have to take enzymes with my meals.

Since iron supplements did not help me even after so many years, I stopped taking them. My hemoglobin seems to stay the same either way.

Keeping a diary helps, that way you may be able to identify what causes problems for her.

She is having a lot more good days on the new diet.

We had a slip up with milk and she was sick for 2 days.  This has made her much more carefully but trying to avoid milk and milk products.

She hasn't missed any school in the last two week, which is a good thing as she has began fast start for year 11.

She swimming times have improved slightly and still a long way from what she was 12 months.

She has lost 5 kg which is quite concerning as she has no weight that she can afford to lose.

On side note my middle daughter has been to seen a specialist because she thinks is short.  Outcome she is not short as she falls between 10% and 90% on growth charts but as she is more that 10 cm shorter that what her expect height should be using her parent heights the doctor has ordered blood tests and waist scan and she will be tested for anemia for the first time.  During some of the blood tests order it will six weeks for results.

Catherine

Pretty

Currently doing a iron tablet trial for six months.

4 month blood test due this week.

Her fathers sister has problems with fructose and lactose, and after the change in diet her hemoglobin levels improved.

Catherine.

Sarah last blood test show the hemoglobin level has remained stable but iron levels other the S Ferritin are still low.

Results are as follows:

Haemoglobin 93 L
Hct 0.30 L
RBC 4.1
MCV 72 L
MCH 23 L
MCHC 317
RDW 16.4
Platelets 312
White Cells 3.9 L
Neutrophils 2.6
Lymphocytes 0.7 L
Monocytes 0.4
Eosinopils 0.1
Basophils 0.0

S Iron 3 L
S Trf 1.8 L
S TRF Sat 7 L
S Ferritin 80

This is the first test where White Cells and S Trf been marked as low.

The doctors has decided to test for alpha thal as she was not happy with these results.

Catherine,

What test will they be doing for alpha thal? Her MCV and MCH and previous electrophoresis all support a possible alpha thal trait diagnosis, but they also support an iron deficiency diagnosis. In the end, a DNA analysis is the only sure method to determine alpha trait.

Hi Andy

I not sure what test they have done will try and find out a post results when I get them.

Sarah and I have decided to stop the iron tablets to see whether the IBS improves.  She has been taking the iron tablets in the morning.  She stomach begins to ache round 4pm (mild) and as night progress get worse.  The pains is so bad that it wakes she up around 3 am and she rolls around in pain.  She has these pains for 7 days straight.

Pretty

How did you know that the iron tablets were making your IBS worse?