For the "experts": a letter from Jim and an answer from Larry (not a doctor!) about iron levels during maintenance.

(The info is from the excess-iron-list,  details below this mail.)

Well, folks, after all this time, I have come to the mountain seeking answers to a dilemma. I couldn't think of a finer resource than y'all. I’ve included a series of my Iron Panel and selected CBC values that have been measured over the past several months. The results of the most recent tests are baffling; thus I am hoping that all you HH gurus may have some suggestions. My new doctor is baffled also, but sincerely concerned. First, I’d like to point out a few things that may be useful for analysis.

  1. I am in the process of changing providers, which as many of you know can be a hassle. I have generally maintained my ferritin between 10 & 25 for the past 8 years. The increase to >30 I feel confident in attributing to the length of time between phlebotomies.
  2. The values in rows 1 & 4, along with the phlebotomy on line 2 are from a provider that I am leaving. The remaining rows are values and phlebotomies from the new provider.
  3. There is a dramatic difference between the values in rows 3 & 4. Row 4 is the old facility, Row 3 is the new facility. (You noticed that I didn’t burn my bridges until I crossed over.) What is significant about these values is that there was not an intervening phlebotomy, yet a decrease occurred. My initial reaction was that the new provider’s lab values were tainted, as the former provider’s lab values had been consistent over the past 8 years.
  4. The questionable row 3 values were somewhat confirmed be subsequent tests by the new provider, given that 7 weeks had lapsed since my last phlebotomy, as indicated in row 5. I had 2 phlebotomies, a week apart as a result, as indicated in row 5 & 6, because the phlebotomy on 12/13 did not result in a full unit. As my numbers warranted an additional phlebotomy, one was done the following week.
  5. 3 weeks later, on 1/3/01, I had another Iron panel and CBC resulting in a really dramatic lowering of percent saturation. Questioning those results, another series of tests were taken 10 days later. The ferritin, serum iron & percent saturation have once again dropped dramatically. At this point, one begins to wonder.
  6. I have not detected any type of bleeding in my waste, nor are my ankles swollen, as in the gravitational flow of blood to the lowest level. Furthermore, I have not detected any decrease in my energy levels or my ability to focus: the usual indication of needing a phlebotomy.

My question is, does anyone have ideas as to what may be going on? I’m not looking for a diagnosis, simply ideas.

The differences in labs can not singularly account for such a dramatic decrease in values, at least I don’t think so.

Thanks

Jim H

 

Iron Panel

 

Selected CBC Values

 

Units ->

ng/mL

ug/dL

ug/dL

(iron/TIBC)

 

g/dL

%

mL

Ref. Range ->

20 - 300

40 - 180

250 - 375

20% - 30%

 

13.8 - 17.8

40 - 50

500

Date/Time

Ferritin

Iron

TIBC

%Saturation

Transferrin

Hgb

HCT

Phlebotomy

 

 

 

 

 

 

 

 

 

10/4/00 8:00 AM

16

84

256

32.81%

 

15.3

45.0

 

10/13/00 9:00 AM

 

 

 

 

 

 

 

300

11/3/00 11:30 AM

28.6

309

305

101.31%

244

17.0

49.0

 

11/28/00 8:00 AM

31

179

299

59.87%

 

15.2

45.0

 

12/13/00 8:30 AM

36.9

223

254

87.80%

203

15.0

44.7

300

12/20/00 8:00 AM

 

 

 

 

 

 

 

500

1/3/01 8:00 Am

11.4

44

343

12.83%

274

13.0

 

 

1/13/01 8:00 AM

9.6

28

325

8.62%

260

13.9

40.8

 

 

 

Answer from Larry:

 

Hi Jim

I've studied and thought about the results you shared with us. I am looking at the results more from a standpoint of overall trends, taking a step back, as it were, to look at the big picture. I've looked at plenty of lab results over the years to know that a single set of results may not fit the trend and seem to have know logical explanation. I'll talk about the trends I see and speculate as to the results on 11/3/2000 with the 101% sat and 17.0 hgb.
 
 Overall trends (unless stated otherwise, I'm ignoring the result from 11/3/2000). I'm looking at the results from the standpoint of before and after you had the phlebs two weeks in a row:
 
 BEFORE THE PHLEBS TWO WEEKS IN A ROW:
 Your hgb runs a little above 15, that appears to be "normal" for you. As you said, your ferritin has been maintained at 10-25. Your TIBC (indirect measure of transferrin) was running below 300 (256, 299, 254). I have noticed that (in general, not just your case) the TIBC gives us an indication of what the body perceives is our iron status. If the overall iron stores are lower, the transferrin will begin to rise. As iron stores begin to rise, transferrin begins to drop.
 This is obviously reflected in the %sat. Serum iron will also rise in times of "iron-loading" but has the additional variable of recent diet to consider as well. So, your ferritin is on the rise (16, 31, 36.9), your hgb is remaining fairly constant (15.3,
 15.2, 15.0: normal degree of variation in an individual), your serum iron is climbing (84, 179, 223), your %sat is climbing (33, 60, 89). At this point all indications point to the need for a phleb.  You had the partial phleb (300 mL) on 12/13 then the
 full phleb (500mL) the next week.
 
 AFTER THE PHLEBS TWO WEEKS IN A ROW:
 After the two phlebs, your ferritin went down to 11.4 then continued to drop to 9.6 (this is basically the
 same result, round them off to 11 and 10; this difference can reflect normal physiological variation
 as well as instrument variation in measurement). Your hgb dropped from 15.0 to 13.0 then began to rebound
 back up to 13.9. The drop from 15.0 to 13.0 as a result of 800mL of blood loss is normal, as far as I
 am concerned. It shows me that you were maintaining ferritin level well under control and the two phlebs
 got you right back where you need to be. I predict your 13.9 hgb is on its way back up to your normal of
 15.0-15.5. After the two phlebs, your TIBC climbed up to well over 300 (343, 325). I think your body is
 saying we're getting iron stores in the lower end of normal, so the TIBC (transferrin) moves up
 accordingly. Your serum iron levels(44, 28) reflect good fasting values. Your %sat (13, 9) reflects
 excellent control and I think the big picture shows a normal response of rising stored iron levels being
 brought back into control by the two phlebotomies.
 
 WHAT HAPPENED ON 11/3/2000?
 Others may have responded by the time I get this sent and covered this. To me, the only two values that are
 suspect are the serum iron of 309 (which affects the 101% sat) and the hgb/HCT of 17.0/49.0. I have three
 thoughts about the test results on that day. The chemistry tests are run from one sample and the
 hematology (hgb/HCT) on a separate sample.

1) The time of collection was 11:30 am. Was it fasting? (If so, weren't you starving by then? I've got to eat soon after I get up). If not, that might partly explain the serum iron of 309.
 2) Were you possibly dehydrated at the time of the sample collection? That could elevate the hgb/HCT.
 3) Bad sample.
 
 Overall, I think things look pretty good.
 
 Respectfully
 
 Larry

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