ferratin and iron

[fiftyone]

What is the relationship between ferratin and iron. Doctor tells me my ferritin is good but I see my iron is low and my transferrin is abnormal. I also feel very fatigued, low concentration and hair thinning. Doctor says because my ferratin is good, I don't need extra iron.

[traveltime]

I’m not not medical, and my results may not be relevant to your specific situation, but my ferritin is high within range and iron/transferrin are really low/below. My doctor said I have relative iron deficiency and has prescribed some iron tabs.

[Orchard33]

I would suggest you take heme iron and see what happens over 3 months. A complacent response from your medic in my view.

[fiftyone in reply to Orchard33]

I don't absorb well through my stomach

[Orchard33]

I don't absorb well and can't handle the usual synthetic forms of iron. But I can absorb heme.

[fiftyone in reply to Orchard33]

was this prescribed by your doctor

[Orchard33 in reply to fiftyone]

No. Learnt about it on this site.

[QUE6T-33 in reply to Orchard33]

What is heme iron ?

[Orchard33 in reply to QUE6T-33]

It is bovine-derived rather than a chemical.

[QUE6T-33 in reply to Orchard33]

Ah, ok.

[FlipperTD]

Here we go...

Scientist, not medic.

Iron metabolism is a bit complicated. The problems include the fact that Iron is comparatively scarce in the environment, so we don't have any means of getting rid of excess, except by blood loss. Total body iron is not that much [somewhere between about 5 grams and 20 grams, normally.] Each time you lose 1ml of red cells, that takes away 1mg of iron. You replace all of your red cells in about 4 months. In that time, the iron in haemoglobin is scavenged and re-used. It's stored initially as ferritin, and that is then stored as haemosiderin. When it's called on for making red cells [and other stuff, but haemoglobin is by far the greatest use] then it's pulled out from storage, and re-used.

To make matters more complex, when we measure ferritin, we're measuring the protein, not the iron. Ferritin is an acute phase reactant, which means that if you get any inflammatory process, chest infection or whatever, your ferritin will rise, and then come down again on recovery.

Transferrin it is a transport protein for iron, and it's measured by immunoassay. Serum Iron is measured 'chemically' rather than by measuring a protein.

If your doctor says you don't need iron, then it's best to listen and trust them. Iron in excess is toxic. Once it's in, it's hard to get rid of. An FBC is a good indicator of whether you're in need of iron, because your red cells, being constantly updated, will soon show whether there's an issue as your MCH and MCV fall first, and then eventually your Hb will fall too. If your FBC includes an RDW, than that will go up as things start running out as well.

Don't simply start self-dosing with iron. A 'normal' [as in meat-eating] diet should provide everything you need, unless you have a chronic bleeding problem.

Good luck.

[fiftyone in reply to FlipperTD]

what you say is difficult for me to undertand. Firstly, I don't absorb well through my stomach. I'm on PPI and metformin which I understand mitigates against some absorption. I have regular B12 injections. I had an iron infusion earlier in the year and after a few weeks I felt better. Sincet then my iron has plummeted to 7 and my transferrin in abnormally low. I now feel constanly tired, even after 7 hours sleep, my concentration is poor, I have had a chronic cough for months and my hair is badly thinning.

So if my ferritin level is good, why does this not transfer into good iron levels? And if I have iron deficiency symptoms why does low iron and transferrin not responsible? I'm very puzzled.

[fiftyone in reply to FlipperTD]

what's more.....I have abnormally low zinc. What I fail to understand is this.If the doctor ignores these low levels, saying 'I'm normal', why isn't he trying to find the answer to my health problem?

[FlipperTD in reply to fiftyone]

Sorry if I've confused you!

If you're on PPI then that stops your stomach producing acid. You need acid to be able to absorb iron. If your ferritin is normal, that doesn't always mean that your iron status is good. Serum Iron and TIBC can be of more help. Plus an FBC.

[fiftyone in reply to FlipperTD]

but I do have too much acid. I constantly feel acidity in stomach and chest and have been diagnosed with acid reflux. That's why I' on PPIs....to reduce the acid. but PPI and the metformin then mitigate against certain absorption. Thanks for all the info and your support.

[LadyBothwell in reply to fiftyone]

Has your stomach acid actually been tested? The symptoms of high snd low stomach acid are similar and often misdiagnosed I had acid reflux before I was diagnosed with Pernicious Anaemia. I was put on PPIs which destroyed by b12 level completely and ability to absorb iron. Only got better when stopped PPI and had more b12 injections.

[fiftyone in reply to LadyBothwell]

but when you stopped PPIs did your acid reflux/stomach acid return? I feel acidity in my stomach and sometimes my mouth. I was xrayed and diagnosed with acid reflux.

[LadyBothwell in reply to fiftyone]

The PPis stopped the symptoms but made my b12 deficiency worse to the point it was almost untraceable and I was housebound. The Doctor who diagnosed PA was horrified my GP gave me PpIs and stopped them immediately and increased frequency of b12 injections. I'm sure the reflux came back temporarily but I was so b12 deficient symptomatic at that time that was only one thing. It took time but I dont have symptoms of acid reflux now. I'm careful about what I eat and add acidic foods and drink to my day eg apple cider vinegar , lime juice etc with my meals. I have iron deficiency with recurring anaemia, the doctor says it is also an absorption problem. I also have inflammatory bowel disease much if what I tried with all this was trial and error and keeping a symptom diary.

[fiftyone in reply to LadyBothwell]

what were your obvious symptoms of B12 deficiency

[LadyBothwell in reply to fiftyone]

Fatigue, diarrhoea, constant upset stomach and indigestion, acid reflux, urinary and bowel incontinence tinnitus, breathlessness, brain fog, forgetting words, stopping mid sentence, general confusion, pins and needles in feet and fingers, dropping things walking into walls, getting physically lost and forgetting where I was, irritability, anxiety, feeling tearful for no reason , halucinatory smells, picking up every bug and cold, heart palpitations, sore and swollen tongue with strange crinkly edges, mouth ulcers and a twitching right eye, hair loss and breaking nails. Oh and I was sleeping around 16 hours a day and never woke feeling refreshed .

I just got this from my symptoms diary I kept, it was horrific now I've remembered it and don't ever want to go back there!

I sound like a bundle of joyful fun then!

[fiftyone in reply to LadyBothwell]

that all sounds horrific. Did the doctor recognise all these symptoms as b12 deficiency or did he/she try to solve each problem separately...with different medications

[LadyBothwell in reply to fiftyone]

My GP was hopeless unfortunately. Eventually I got referred to a haematologist who was knowledgeable and he saved my life. Yes he said they were all potentially symptoms of b12 deficiency and some were also iron and folate deficiency which I was also low in . He was able to see this on more detailed blood tests and a blood film. I was anaemic my blood cells were mishappen. They are symptoms also listed on the Pernicious Anaemia Society's website which I looked at and read Martyn Hoopers book. There are other symptoms too, not everyone gets the same combination. Some of mine come back when my injection is due. But I manage quite well now.

[fiftyone in reply to LadyBothwell]

glad to hear everything is being well managed now. Thank you for your interest and your information.

[LadyBothwell in reply to fiftyone]

I don't know what the test for acid reflux is sorry, if your doctor says that's what it is then fine. Im just saying my GP was wrong about mine

[FlipperTD]

I understand that, but drugs that don't have side effects often don't have much in the way of effects either. By reducing stomach acidity, that will inevitably reduce your ability to absorb iron. However, if you need iron then there are other ways that will work. That's down to your doctor to sort out.

[Oneash]

How often are you getting B12 injections?

[fiftyone in reply to Oneash]

once every eight weeks.

[Oneash]

You may need it more frequently, especially if you are breathless due to Anemia.

[fiftyone in reply to Oneash]

no, I'm not breathless.....