Iron deficiency and dysregulation

[Leila]

That doctor needs to do some revision on ferritin. Pathogens can access free iron in the blood stream, and this helps them to reproduce. But they can't access iron which is stored in ferritin. So the body stores as much iron as possible in ferritin (in cases of infection/inflammation) and leaves as little as possible as free iron.

See page 8 in this newsletter : https://web.archive.org/web/2020021...ers.org/Websites/idi/Images/4QTR2008FINAL.pdf

Thank you! So ferritin levels should not be affected by infections?

For yrs I thought my low ferritin might be due to heavy periods but that wasn't the cause either.

 

[Mij]

Every time a new doc realized my iron & ferritin stores were low they were Aha! We can fix that! Very common in women of menstruating age.

When I pointed out I have tried virtually every iron supplement you can think of I was assured but this one will work. Only to be told to take a fairly common product that didn't help. Again.

Made no difference pointing out that like many hypothyroid women my periods were generally quite light.

The odd thing is that my periods were always light too. Since menopause, my ferritin is now steady at 95. My GP kind of laughed when I was surprised to see my ferritin so high, not understanding that my periods were always light.

I should also add that my copper (ceruloplasmin) which plays a role in iron metabolism was also below normal range.

 

[Arnie Pye]

So ferritin levels should not be affected by infections?

Ferritin IS affected by infections. Ferritin will rise when someone has an infection because the body is removing free iron from the blood stream or any other tissues containing free iron and storing it away from any pathogens in ferritin. But serum iron will drop, often quite a bit below range.

 

[Arnie Pye]

I should also add that my copper (ceruloplasmin) which plays a role in iron metabolism was also below normal range.

I think that is quite unusual. Zinc and copper compete for absorption, so someone with low copper probably has high zinc, and someone with low zinc probably has high copper.

I've never understood the relationship between copper and iron, although such a relationship does exist, apparently.

https://en.wikipedia.org/wiki/Ceruloplasmin

 

[Leila]

Ferritin IS affected by infections. Ferritin will rise when someone has an infection because the body is removing free iron from the blood stream or any other tissues containing free iron and storing it away from any pathogens in ferritin. But serum iron will drop, often quite a bit below range.

Got it, thank you!

 

[DokaGirl]

My sister has Hashimoto and takes iron regularly to keep her ferritin in range.

Hi @Mij I've read that iron deficiency can affect thyroid function. Makes sense. Also, iron needs to be taken several hours away from thyroid meds. (Calcium too.)
.

 

[Mij]

@Arnie Pye

Apparently, copper deficiency is rare. It goes to show that our minerals, amino acids and fatty acids are not being absorbed properly.

I had the profile of someone who was malnourished despite eating a very healthy diet and drinking fresh veggie juices every day. I took digestive enzymes for many years, and that did help.

 

[DokaGirl]

@Arnie Pye

Apparently, copper deficiency is rare. It goes to show that our minerals, amino acids and fatty acids are not being absorbed properly.

I had the profile of someone who was malnourished despite eating a very healthy diet and drinking fresh veggie juices every day. I took digestive enzymes for many years, and that did help.

We've talked before about this. After testing, and not by a quack, I was told to eat more protein, I was very low in iron, and to eat more salt. The results were unexpected as I ate quite a bit of animal protein, seemingly shouldn't have been low in iron, and added salt to my meals, mindful of the advice to do this for OI.

I have a few quite bothersome GI issues. But have never been tested for malabsorption. It makes me wonder about ME and potential absorption issues. I haven't checked to see if anyone has researched this area. There has been info about pwME needing more nutrients than average.

 

[TigerLilea]

@Jonathan Edwards thank you for your comments. From everyday observation, I would say the point that ferritin levels can be over looked is important. But I think I understand where you're coming from on this.

Wouldn't Ferritin levels be one of the first tests that a doctor would run when looking at fatigue? At least is my part of the world it is.

 

[Wonko]

The NHS (UK) has never tested my ferritin levels. I only know what they were coz a ferritin test was included in a private thyroid screen I had done a while back.

The result was 'high' - 1017 - so I'm fairly sure that in my case 'fatigue' is not caused by low ferritin

 

[TigerLilea]

The NHS (UK) has never tested my ferritin levels. I only know what they were coz a ferritin test was included in a private thyroid screen I had done a while back.

The result was 'high' - 1017 - so I'm fairly sure that in my case 'fatigue' is not caused by low ferritin

My dad complained about 'feeling half dead' and one of the first things the hospital checked were his ferritin levels. That was how his colon cancer was discovered. Ferritin seems to be a common test that is done here in Canada.

 

[DokaGirl]

Wouldn't Ferritin levels be one of the first tests that a doctor would run when looking at fatigue? At least is my part of the world it is.

Thank you @TigerLilea for your comments. It's good to know that is what you have seen. But I've never seen this. Ferritin level is never on the first go round of testing. If Hemoglobin is fine, that's where it stays as regards iron level testing. Patients have to know to ask for a Ferritin level. It would be helpful if this would change, so patients don't have to know to ask for a ferritin level test.

 

[Wonko]

Surely on it's own a ferritin test is not that helpful, unless the level is particularly low?

Surely in order to get anything useful, if only to allow meaningful interpretation of the ferritin level, an iron panel is needed?

 

[Arnie Pye]

Surely on it's own a ferritin test is not that helpful, unless the level is particularly low?

I would agree. Just because someone knows their ferritin level doesn't mean they know all there is to know about their iron status.

 

[Arnie Pye]

The NICE Clinical Knowledge Summary on Iron Deficiency Anaemia suggests the following investigations when anaemia is suspected. I don't think this link is available to people outside the UK.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/investigations/

It does say this :

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

and this :

Ferritin levels can be difficult to interpret if infection or inflammation is present, as levels can be high even in the presence of iron deficiency.

For anyone interested in iron deficiency anaemia and how it is supposed to be diagnosed, there is far more info on that link than I've suggested above.

Start with this link and pick out the things that interest you.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/

 

[Amw66]

The NHS (UK) has never tested my ferritin levels. I only know what they were coz a ferritin test was included in a private thyroid screen I had done a while back.

The result was 'high' - 1017 - so I'm fairly sure that in my case 'fatigue' is not caused by low ferritin

I did read previously that high ferritin and high GGT ( liver marker) can inidicate insulin resistance ( and can be an indicator for NAFLD)
So if you are diabetic then this may possiblybe why your ferritin is high.

 

[Mij]

If your GP goes strictly by reference range then you might be in trouble if you're not receiving your lab results.

A ferritin reference range of 12 to 150 ng/mL is not a good indicator. Anything below 20 is the first sign that I don't feel right. I feel best at 50+. Maybe it's just me though.

 

[DokaGirl]

Interesting @Arnie Pye that ferritin level can be high with inflammation or infection even with iron deficiency. Tricky. I wonder if this has any ramifications for pwME.

 

[DokaGirl]

Here is a retrospective study re ferritin looking at the issue of it not necessarily being ordered by GPs, and suggestions to improve this.

J Family Med Prim Care. 2017 Jan-Mar; 6(1): 69–72.
doi: 10.4103/2249-4863.214986
PMCID: PMC5629903
PMID: 29026752
HWA: Hypoferritinemia without anemia a hidden hematology disorder
Hassan A. Al-Jafar1
Author information Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

Go to:
Abstract
Introduction:
Anemia is a condition, in which the number of red blood cells (RBC) and the hemoglobin (Hb) is insufficient to meet the body's physiologic needs. Hypoferritinemia without anemia (HWA) could cause masked clinical manifestations as general weakness, easy fatigability, depressed mode, and hair loss but with normal complete blood count (CBC) parameters. HWA is deferent from iron deficiency anemia (IDA) because there is no reduction in the RBC, Hb, or any of the other parameters of the CBC. In HWA, the hypoferritinemia could be missed because serum ferritin not always requested by general practitioners. (my bolding)

Materials and Methods:
A retrospective study conducted on 6993 patients of hypoferritinemia patients from our computerized database from 2010 to 2016. The parameters investigated to detect HWA disorder were serum ferritin, RBC, Hb, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin.

Results:
HWA is found in 130 (0.018%) hypoferritinemia patients, in a ratio 1.7–1 females to male.

Conclusion:
HWA is a masked hematology disorder which needs new nomenclature to distinguish it from IDA because they are two deferent disorders although both of them have low serum ferritin. HWA is not a latent IDA because it could happen in patients whom will not get anemia as in polycythemia patients on recurrent veinesection treatement.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629903/

 

[DokaGirl]

Surely on it's own a ferritin test is not that helpful, unless the level is particularly low?

Surely in order to get anything useful, if only to allow meaningful interpretation of the ferritin level, an iron panel is needed?

Yes, absolutely.
These tests should be done.
To my knowledge, and what I've observed happens is the ferritin is left out, not the other measures that are also very important.
The other iron measures such as HB are usually done.
If those other measures are OK, ferritin is less likely to be done, as per the article above.

Others may disagree.