My cancer and treatment have brought me to the point where I'm anemic. My hemoglobin is at 8.2 g/dl, and my serum iron at 21 mg/dl. At the same time my ferritin is 1295 ng/ml. My body is storing the iron in ferritin, rather than using it to create blood cells.
I understand that this is seen with cancer and with inflammation in general. Since I just had the inflammation from the nerve impingement,?the hope is the system will come back into equilibrium after my radiation treatment.
I'm wondering if Nal and others have thoughts on how to stimulate my body to use the iron stored in ferritin to raise my serum iron and create new blood cells.
I tried spending time at altitude over the holidays, but that didn't have a measurable effect. In hindsight, that was at the same time tha lesion in my back was growing, so there could have been a competing effect.
Any thoughts are appreciated b
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I consulted about this situation and they do not do use these drugs unless hemoglobin is south of 8 and there is not extensive bone marrow infiltration by the cancer.
Be advised that serum iron can vary a lot during the day. My iron is usually at the higher end of the normal range. One day it climbed to 217 (Lab's normal range 60-160). I visited a hematologist at a major hospital who ordered a comprehensive in house panel. It came back at 108 (hospital's normal range 70-180). When I asked him how can these differ by that much (2:1) his answer was that this isn't unusual.
My usual routine for blood draw is about one hour after waking up and 12+ hours of fasting. Under these conditions serum iron attains its highest concentration. My hospital visit was around noon and if memory serves I had breakfast that morning.
When my ferritin was elevated (though a small % of your level), my doctor advised me to lower it via phlebotomy. But maybe that isn't such a good idea when red blood cells are low? Has anyone expressed concern about your ferritin level?
Erythropoiesis (the creatiom of red blood cells) declines as testosterone levels fall. Men on ADT are often close to being anemic, if not actually anemic.
As someone on ADT who injects a hugh dose of testosterone cypionate every 3 months, I suppose that my RBC substantially recovers. I should do a blood test to check that out.
The idea of interrupting castration with testosterone will seem outlandish to most doctors & patients alike, but the idea is to shock the cancer out of adaptations it has made to low levels of androgen.
Anyway, testosterone restoration will quickly restore hematocrit levels. (Now everyone will think me crazy.)
Nal, What do you think of Inositol (IP6) if he has hemochromatosis ? Many people have used Inositol to reduce hematocrit. But, in case of anemia, it may not be safe.
I think it's good to rule out hemochromatosis, but it hasn't shown up before. I've never measured ferritin before the cancer, but it was 417 on July 22.
If it's hereditary, then would expect continuous ekevated level and continuous anemia. I've never been anemic. Hemoglobin was 13.6 last February. Just.1 below normal range with cancer growing quickly.
I do have hemochromatosis and am currently being treated with EBRT but I need a phlebotomy every couple of weeks or so when my ferritin gets above 50. My hemoglobin has stayed in the 16-17 range. Because I can't donate due to my cancer treatments, the cancer center I go to does a therapeutic phlebotomy every few weeks before my radiation and it works out fine.
I doubt you have hemochromatosis but the only way to diagnose it is through genetic testing. Although it is possible for those with hemochromatosis to become anemic it is rare and almost always caused by another disease process or treatment.
Thanks for that information. I'm glad to have a deeper understanding of what henatochromatosiscis like. I don't think I have it.
My man question for this thread was what can be done to convert ferritin reserves caused by chronic inflammation to convert to hemoglobin. It seems that will happen naturally if hemopoeitin triggers blood cell creation.
I was thinking that the ferritin storage is my body protecting myself from too much serum iron while the damaged marrow is unable to use it. What runs counter to that hypothesis is that my serum level of iron is low. It looks like it is driven primarily by inflammation. Hopefully that will resolve the further I get from treatment. I think that's what the MO is waiting to see.
Ferritin is known as an acute phase reactant, it is more of an indication of inflammation than of iron stores. What you might want to do is request what is known as an iron panel from your lab., which consists of ferritin, total iron, transferrin saturation and total iron binding capacity. This will give you an idea of whether the elevated ferritin is your body protecting itself from to much iron or not.
The place I go to also has a hematologist on staff so you might want to consult with a hematologist at your local facility to do more testing to determine your actual iron storage status, in particular I'd pay attention to the total iron binding capacity which would be far more accurate than ferritin in determining your real bodies iron stores..
Your TIBC is within normal range and actually your ferritin is just outside the normal range for males, mine was about 2500 at diagnosis, they become concerned with iron deposition in the liver and other organs with values over 1000. Your total saturation indicates anemia but, in my opinion, nothing indicates you are storing iron, of course I'd rely on your doctor's opinion and not mine but it seems to me the traditional treatment for anemia (iron supplementation) is indicated in your case.
Suggest looking up pomegranates as a source of iron to combat anemia due to its high vitamin C content which enhances the body's ability to absorb it's iron content. Be aware that a surfeit of pomegranate can contribute to constipation.
I remember reading in medical history book that the treatment for Hemochromatosis decades ago.. used to be attaching leeches ( those animals who suck blood ) and take out blood from the person.
Just to be clear: you are anemic in the face of excess iron stores. Ferretin reflects your iron stores, as you seem well aware. You do not need to enhance iron intake or uptake!Yet you are anemic but not due to iron deficiency or blood loss, etc. You do not need serial phlebotomy as is used for hereditary hemochromatosis. Those ones have excess Hb and RBCs, not low. So the phlebotomies help them.
Your anemia is of a different cause, a failure of hematopoiesis in the marrow for some reason (cancer, medication, nutritional, renal failure etc.). Several possibilities and other types to consider and sort out. Medical oncologists are also trained hematologists. Yours should “work it up”, looking at a blood smear microscopically (themself) for clues, RBC indices, B12 and folate, thyroid and renal function and such.
. . . And if all specific causes are eliminated, then it is often concluded to be “anemia of chronic disease”. ESAs May be appropriate to help. And the deferoxamine, may be discussed to reduce iron stores without exacerbating the anemia, as Nal pointed out. Hope it doesn’t make a hitch with the CAR-T trial.
pjoeshea13 mentioned Erythropoiesis. My wife has chronic kidney disease (CKD) that harms her ability to naturally make enough Erythropoietin that normally stimulates the bone marrow to make red blood cells. Her hemoglobin is typically below 10. The treatment is regular injections of Erythropoietin replacement through one of the biologic injectables: Procrit or Aranesp. I've understood, however, that anemia brought about by ADT has a different causality than does Erythropoietin deficiency that is kidney/bone marrow related - - not sure about that, however, so it might be worth asking your oncologist and a hematologist about that.
I was wondering if you tried iron supplements or dietary approach to increase your iron serum numbers. Nobody mentioned it. Sometimes the problem is so simple to solve.
Supplements should relieve the anemia, but I already have plenty of iron in my system. I just got a cabazitaxel cycle, so I'm waiting for that to settle out. MO is concerned that oral iron supplements cause constipation, so I'm waiting a few days for my digestive track to recover from chemotherapy before taking them.
My dad had a very very similar case. The anemia was due to bone marrow infiltration but he also had incredibly high ferritin - similar and even higher numbers than yours. We never truly figured out the high ferritin (stumped the oncologists as well) but were told it is a non-specific inflammatory marker. ESA or EPOs wouldn't help because his issue wasn't in his kidneys, just in his bone marrow.
Blood transfusions were helpful for the anemia and NSAIDs (specifically Naproxen) were best used to manage the inflammation and lower the ferritin numbers. Also used Dexamethasone for inflammation.
I think my bone marrow went affected by the Lu -PSMA therapy at the same time my inflammation had spiked from a lesion on the L3 nerve root. On top of that, I got my first cabazitaxel cycle on Thursday. A lot to recover from all at once.
My sister offered to donate blood, which might grt me past the current problem.
Thank you all for the in depth lesson in iron use. Looking at my Total Iron Blood Concentration (TIBC) it looks like the simple answer of supplements is it. I don't see any danger in serum levels going to high, once the ferritin releases the stored iron.
Very interesting post. I am anemic caused by long term ADT and AC225 and lu177 my Ferritin is 6 and a bone scan is - 3. Just discovered the low Ferritin. I do take bovine spleen.
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