could someone help interpret iron panel labs please

[Spondonhouse]

I’m a 66yr old male and about 4 years ago I was feeling tired and lethargic so my wife suggested a thyroid function test. The labs showed that my thyroid gland was indeed beginning to struggle and that my WBCs were showing some anomalies. I was subsequently diagnosed with CLL but since then my thyroid has been largely ignored despite the numbers getting worse. More about that later because for now I’d like to know what I can do about this strange iron panel

I should add that I erratically supplement with Metabolics iron liquid because my ferritin levels have never been fantastic but are usually somewhere between 50 and 90, so this latest result is a bit of a surprise

26/07/22

Ferritin 19.2 (22 -322)

Serum iron 21.4 (14 - 31.3) 42.77% through range. According to rT3 adrenals, in men, nearer 70% is better 

Transferrin 2.52 (2.15 - 3.65) 24.67% through range. I think this might be considered low and therefore shows a lack of capacity for more iron, according to rT3

% Saturation 37 (16 - 50) Again, rT3 says in men, nearer 45% is better

Any comments on how I can safely raise my ferritin levels given that my transferrin level is suggesting I shouldn’t be supplementing with iron. I’d also be interested in your thoughts on the connection between thyroid function and CLL because although she hasn’t any evidence my wife wonders could a struggling thyroid trigger a cascade of events that impact the various systems within us. It’s a fair comment I think. She has Hashimoto’s and has noticed all sorts of things going wrong since getting it, including liver problems

Thanks all

[SofiaDeo Administrator]

Since the thyroid gland is involved in red blood cell production, if it were me, I would get my thyroid issues investigated/resolved as well as possibly a bone marrow biopsy. From the few labs you have given, it's hard to say if thyroid, CLL, or something else is causing/contributing to the problem, and to what extent. A full iron panel workup may show that it's a low vitamin B12 or other problem, not iron stores.

Think of body homeostasis lab numbers as a pizza pie balanced on top of a triangle, with the various numbers of lab values lined up along the edges. The pizza remains level when everything is "normal" or balanced. A problem in one or another makes the pizza tilt one way or another. Until the underlying cause of the original change is addressed, you won't get back to balance. One can't just try to raise or lower a single value, that's a temporary measure.

Not sure if links are working yet, but I'll try

Thyroid and red blood cell production:

wi.mit.edu/news/mystery-sol...

Causes of low ferritin:

healthhearty.com/low-ferrit...

[Spondonhouse in reply to SofiaDeo]

Yes, I realise it’s might be another underlying issue and that of course my body is now out of balance. Homeostasis has been disturbed and as my wife has suggested, all manner of internal workings are being affected

I merely wondered in the first instance, how to raise ferritin safely and slowly. Getting to good levels will inevitably positively improve my fatigue and lethargy and in the meantime I’ll be looking at what else may be going wrong or causing low nutrients. We suspect malabsorption/gut issues because our diet is excellent

My TFTs are booked for when I return from holiday; it’ll be interesting to see where they are

Thank you for providing the links

[LeoPa in reply to Spondonhouse]

What do you mean when you say your diet is excellent?

[Yalokin]

B12 deficiency affects all body systems and is a great mimic that can mimic a variety of medical problems. In addition to neuropsychiatric manifestations, it can cause shortness of breath, fatigue, general weakness, anemia, indigestion, gastroesophageal reflux-like symptoms, constipation, diarrhea, weight loss, recurrent miscarriages, pap smear abnormalities, infertility, osteoporosis, impaired healing of wounds and weakened immune responses.

The deficiency risk group includes all patients with gastroenterological problems: acute and chronic gastritis, ulcer, enteritis and colitis, gastroesophageal reflux, celiac disease, Crohn's disease, H. pylori, bacterial overgrowth in the small intestine, gastrointestinal surgery, gastric bypass for weight reduction, vegetarianism and veganism, etc

[Yalokin]

To discuss your ferritin panel, many more data are needed: hemoglobin, red blood cells, average red blood cell volume, whether you have inflammation of the gastric mucosa (sometimes it is asymptomatic), because inflammation of the gastric mucosa can lead to malabsorption of vitamin B12. Basically I need a hematologist to comment on all the results together. I have similar results from 4-5 months ago and for 3 months I have been taking vitamin B complex every other day, as well as folic acid once every 4 days. I have an improvement in the last results. I also have reflux esophagitis and I occasionally take a proton pump inhibitor. This also reduces the absorption of calcium and vitamin B12.

You should not take any supplements without consulting a hematologist about the likely cause.

[Spondonhouse in reply to Yalokin]

Thank you Yalokin. I should mention that I do have quite extensive blood work available to look at, amongst which is CRP which is 0.48 (0- 5) if memory serves me

I should also mention that folic acid is an inferior form and wherever possible, when trying to raise folate levels, folate (methyl folate) should be the go to choice for superior absorption

My B12 is high within the range and my folate is climbing

Regarding taking supplements and my under range ferritin my consultant said: nothing to worry about. Do I need to say more

[Yalokin in reply to Spondonhouse]

If your consultant is a hematologist, there is nothing to discuss. We can never know as much as a specialist. Drink your beer (moderately) and sleep easy. This is my layman's opinion.

You have a very low CPR, you are probably not overweight either. Cheers and stay healthy.

[Davidcara]

Seems like you need some iron. Your iron storage ie ferritin is low. I would discuss with your Doctor. Could be any number of things. They generally start with a GI slow bleeding work up, ie colonoscopy and upper GI track scope.