Iron based anemia

Insight Driver

All I can see here is total confusion. I wish for more information and two know-it-alls is all I see bashing each other. My wife is doing the best she can at improving her health with excercise and she has a need as well as I do to learn as much about proper health as possible.

She has normal iron in her tissue, but it is low in her blood. We eat healthy, including meat and iron-rich cruciferous and leafy vegetables. We eat more fruits than most people. Where my blood chemistry is normal, hers is not. What we need are facts that will help her.

patch70

Blood tests done for "iron studies" are one of the most difficult tests to interpret even for senior doctors.

The most important result is ferritin which reflects the body's stores of iron. However, it can be hard to interpret in that the ferritin level goes up when you have any inflammation going on at the time (eg the 'flu or a skin infection). If the ferritin is greater than 100, then you can be sure that you are not iron deficient. If it is very low, then you are likely to be iron deficient.

Women generally have lower levels of ferritin than men because of menstrual losses (1mg iron loss per day) and losses associated with pregnancy & lactation.

The level of iron itself in the blood is not particularly important and should generally be ignored. Many things can affect the level and whether it is low or high does not accurately reflect iron stores. If your ferritin is above 100 and your iron level is low - don't worry as the low iron level is probably not relevant. If both are low then you are likely to be iron deficient.

The haemoglobin level & size of your red blood cells on a "full blood examination" or "complete blood count" are important. The haemoglobin level is what tells you that you really are anaemic. There are many causes of fatigue other than anaemia. If you are anaemic, then further evidence for iron deficiency is that the red blood cells are small (MCV or Mean Cell Volume below 80fl). If you have anaemia with normal or large red blood cells, then it is important to look for causes other than iron deficiency.

If, after all this, the diagnosis of iron deficiency anaemia is made, it is very important to look for the reason why and not just focus on replacing iron. Causes include:
*Blood loss (eg heavy periods, losses from the stomach or bowel due to things like stomach ulcers or diseases of the colon)
*Inadequate dietary intake
*Failure to absorb iron (eg celiac disease or chronic diarrhoea)
*Other rarer causes

With regards to iron replacement, remember that this is a slow process. You only absorb a small % of the iron you take in.
You can absorb up to 30% of the iron in meat, fish or poultry but only 10% or less of the iron in vegetables. It will take a long time to restore your stores fully, especially if losses such as heavy periods are ongoing.

Adding vitamin C will improve the absorption of iron if taken together. Iron tablets are good but some people get very constipated and others can become disconcerted by the way they make bowel motions black.

If you are successfully replacing iron, the haemoglobin should rise by ~2 g/dl in the first 3 weeks or so (that is if you were anaemic to start with).

kokopuffs

Insight:

...don't claim to know it all, just what I've read, learned and been taught. And when someone slams me, I slam back, especially to someone who parrots enitre dissertations. That's all, I simply enlightened this readership to the causes of pernicious anemia and listed a relevant reference, the MERCK MANUAL. Just avoid the namecalling and ad hominem remarks - if you know what I mean.

patch70

How do you justify using the word "enlightened" when what you said was wrong?
Try not to be so sensitive in future.

kokopuffs

Visit this site listed below; it's the MERCK MANUAL used worldwide by health professionals. I've posted the URL for anemias.

Once it's displayed, then please do a search on the words INTRINSIC FACTOR for an explanation of the B12/intrinsic factor relationship with pernicious anemia. It's listed under the subheading Anemia Caused By B12 Deficiency.

http://www.merck.com/mrkshared/CVMH...k.com#hl_anchor

PaintNLady

Ok guys....here are the numbers from my blood work.
Iron Screen FERR (showing low, "L") 3ng/ml; normal is 10-170

IRON/TIBC
UIBC (showing high, "H") 371 ug/dL; normal is 92-365
Transf. % Sat. (showing low, "L") 8%; normal is 15-55
TIBC (in normal range) 402ug/dL ; normal is 229-429
Iron (showing low, "L") 31ug/dL; normal is 35-160

CBC
Hemoglobin (showing low, "L") 10.8g/dL; normal is 11.5-15
Hematocrit (showing low, "L") 33.9% ; normal is 34.0-46
MCV (showing low, "L") 77fL ; normal is 80-100

Now, something that my DR told me was that some cyclists got into lots of trouble because they we loading up on hemoglobin(?) before meets in order to boost up their performance, so I do know that this is important for strenious workouts. As a painting contractor when my iron levels drop, I notice a big reduction in my ability to put in a full days work. And the DR said that it would of course affect my ability to work. If I was just a sit down desk worker, it won't be noticeable.

So......watcha think??????

patch70

Thank you for contradicting yourself and backing up what I said.

The following are from your Merck Manual (which is very 'junior' compared to proper reference textbooks such as Harrison's Principles and Practice of Internal Medicine):

"Classically, the term pernicious anemia defines B12 deficiency caused by loss of intrinsic factor secretion"

"Less common causes of decreased B12 absorption include chronic pancreatitis, malabsorption syndromes, certain drugs (eg, oral calcium-chelating drugs, aminosalicylic acid, biguanides), inadequate B12 intake (usually in vegans), and, very rarely, increased metabolism of B12 in long-standing hyperthyroidism"

"Pernicious anemia is a megaloblastic anemia caused by B12 malabsorption. In this condition, atrophy of the gastric glands is severe, with loss of parietal cells and an inability to secrete intrinsic factor, a necessary cofactor in B12 absorption"

So once again:
There are many causes of B12 deficiency. All of which can cause anaemia.
Pernicious anaemia, which is an auto-immune condition leading to inadequate intrinsic factor, is the most common cause of B12 deficiency but is not the only cause!

Please stop repeating the same error ad nauseam.

patch70

Your results do point to an iron deficiency picture with mild anaemia.
The fatigue level tends to progressively increase the lower the haemoglobin and a level of 10.8 is only mildly reduced.
I hope your doctor is looking into the cause of your iron deficiency!

An extra recommendation if you are on iron tablets - take them away from food (2 hours before or 4 hours after) as many foods contain things that will impair iron absorption.

kokopuffs

Patch:

Refer to your earlier post. This is what you said:

"...There are many causes of B12 deficiency and 'pernicious anaemia' is only one of them - and it is due to a lack of intrinsic factor."

As I said, contrary to what you said, P.A. is not a cause but the result of B12 deficiency.

patch70

For the umpteenth time:

B12 deficiency from any cause leads to anaemia.
This is called megaloblastic anaemia.

Pernicious anaemia is an auto-immune condition that leads to a lack of intrinsic factor.
This leads to impaired B12 absorption and low B12 levels.
This leads to megaloblastic anaemia.

kokopuffs

Then please show me a specific reference where it states that PA leads to a lack of intrinsic factor.

patch70

From your Merck Reference:

"Pernicious anemia is a megaloblastic anemia caused by B12 malabsorption. In this condition, atrophy of the gastric glands is severe, with loss of parietal cells and an inability to secrete intrinsic factor, a necessary cofactor in B12 absorption"

To diagnose PA in someone with low B12, a doctor orders 2 tests:
1. Anti-Intrinsic Factor Antibodies
2. Anti-Parietal Cell Antibodies

Look up Harrisons.
Do a Google Search.

kokopuffs

Think of it this way:

1. The auto immune disease occurs, the anti intrinsic factor antibodies attack.

2. No absorption of B12 occurs.

3. PA results, the loss of rbc's.

The loss of rbc's is the result of all this, not the cause.

patch70

PA was the cause at the start.
For Point 3: Megaloblastic anaemia results, not PA.

PA leads to MA.
Not all MA is due to PA.