Anemia without low iron

Catherine,

I found iron intolerable. It bloated my stomach and killed my appetite. I can relate to the pain it causes. After a short trial on iron I quit. I found I couldn't even tolerate 10 mg iron in a multi. I raised my hematocrit from 25 to 47 solely by a vegetarian diet (a veg diet is a challenge because there is none of the easily absorbed iron found in meats). Often diet is the only long term strategy that works. Keep in mind that taking vitamin C with iron rich meals will aid absorption.

Haemoglobin Electrophoresis  15/12/2011

B Hemoglobin A2 2.8 (1.8-3.5)
B Haemoglobin F <1.0 (<1)

Comments
Results are suspicious for alpha thalassaemia trait.  Testing of the partner for thalassaemia prior to pregnancy is suggested to determine whether genetic counselling and/or prenatal diagnosis are required.  DNA analysis is recommended to investigate for alpha thalassaemia. This specimen has been sent to Southern Health Clinical Genetics Laboratory for further evaluation.  Please refer to their report to follow.

S IRON 2L umol/L (5-30)
S TRF 1.9L g/L (2.0-3.6)
S TRF. SAT 4L (10-45)
S FERRITIN  162 NG/mL (30-200)

As mentioned earlier we have stopped iron tablets to issues with stomach aches.

The doctor wants us to restart in a weeks time. S FERRITIN  has double in a week. Any thoughts on restart iron tablets.
 
Catherine

Maybe, and I say maybe because Andy knows a lot more about it, serum ferritin must raise first more before the other values will start to rise (too)? How are her levels of vit b12? If I am correct one need vit b12, folic acid and iron to boost ery's/young red blood cells.

Conclusion: we need help.

S total b12   303 pmol\L (200-700)
RBC folate 2470 nmol/L (800-3000)

These results are from 3 August 2011

Catherine,

Iron pills gave me severe stomach aches and constipation. Even managing with laxatives was difficult to ease myself.

I would get ok as soon as the iron pills were stopped. In the long term, I developed hormonal problems, which again became normal after my iron was stopped completely.

The ferritin levels look normal, mine are just 10-20. Lets wait for others to reply. What i understand is that normal ferritin does not require iron supplementation. Unwanted iron will cause problems.

Catherine,

Would it be possible to put off iron until you get the results of the alpha thalassemia test? The serum ferritin is towards the high end of normal and has shown a steady improvement. One strategy could be to wait a month without iron and then test again to see if there is change in either direction. I am hesitant to say she should try oral iron while continuing to deal with digestive issues and refining her diet. Oral iron may interfere with your efforts to find which foods she can eat without problems.

FYI, the anemia that matches her current readings is anemia of chronic disease (ACD). If it is found that alpha thal is not present, ACD should be investigated.

Thank everyone for your replies.

We had a trip to the emergency department on Christmas Eve and stayed 5 hours (due to stomach pains).

The hospital has written a letter to the GP asking that Sarah be referred to Gastroenterology.  The hospital was worried about her blood presure and pulse rate.

I am posting results they obtained.  I don't know what most them mean.

Bloods:
hb 90
MCV 72
WCC 14.1
Neuts 11.6
IM screen negative
albumin 18
CRP 80
iron 2
transferrin 1.6
b12/folate normal
TSH normal
BHCG negative

Most likely viral illness with chronicity features

Back to doctors on Saturday for referral.

As of today sleeping about 18 hours day, very pale and grey around eye area

Regards
Catherine

PS Currently not taking iron tablets.

Just received referral letter from doctor. The doctor had also requested a copy of a  report from a  pelvic  ulttasound from 6 months ago which we were led to believe was clear.  Only it is not.

It now looks like the anemia is due to acd. Eg inflammatory bowel disease. Now awaiting further testing to confirm this.

Thanks everyone for support especially Andy.

Catherine

Hi Everyone

Saw specialist yesterday.

She believe alpha thal is unlikely as it should have show up earlier but does need to be excluded.

She also believes Sarah's iron level are zero.  Ferritin is a inflammatory marker.  Currently not taking iron supplements.

Sarah will be hospitalised if her weight drops further.  Now 48kgs, 172.5 cms.  She starting to lose muscle as their is no fat lefted.

Thanks for the group support.

Catherine

Catherine,

I pray Sarah feels better soon. How are the doctors treating her medically?

What does it mean by ferritin is an inflammatory marker? Did the specialists say that the inflammatory bowel disease keeps her iron or ferritin zero?

Regards.

A note about what the body does with iron during illness and this is quite relevant to discussions about anemia. First, let me mention that anemia of chronic disease (ACD) is the most common reason for anemia outside of blood loss. When infection is present in the body, iron is sequestered in the serum ferritin, so that it cannot be used by the infecting bacteria or viruses to grow. An example of this would be when after supplementing with iron, the iron stores in the body remain very low even though the ferritin may rise. The iron is actually being absorbed but the body is not allowing it to circulate freely, but instead produces more ferritin to hold the iron, keeping it unavailable to any invaders. So, in cases of ACD, supplementing with iron is fairly futile, as it won't be available to the body. The correct course is to find a cause of the ACD, rather than attacking the problem with iron, because if the iron is introduced, it can feed the infection. Also, because ACD can also be the result of some very serious illnesses like leukemia, it needs to be investigated fully.

Hi Pretty

Treatment at moment for anemia, weight loss and stomach pain.

1. Constipation (as showed by x-ray) the whole colon is involved.    This will be fixed by the
preparation for colonoscopy early next month. (This is no cause of stomach pain or anemia)

2. Weight loss now taking a supplement which is mixed water.  The supplement is in addition to meals.

3. Anemia should be taking supplements but can cause problem with colonscopy.  Will look at restarting after colonscopy.  Also by then should result for alpha thal testing.

4. Dr following up blood test taking by hospital on 24 December.

5. She is also having a gastroscopy at the same time as colonscopy.  They are looking for bleeding.

6. Also from appointment with dietian.

Regards

Catherine

All the best, hope they find a proper cause soon.

God Bless.

Also started eating gluten again
 

Does your daughter took lacto ferritin as iron supplement? I heard this is also another iron supplement called holo ferritin. Did you ever hear about that?
How went the colonscopy? Is she really intolerant for gluten? I am sorry there are still no decent answers regarding your daughter's health.