Anemia of chronic disease

Hi, I am looking for some advice regarding my iron and ferritin levels. I have been on NDT and been gluten free for a couple of years and generally feel really well. A few months ago I started feeling really tired and achy and my hair fell out more than usual so I asked my GP for a thyroid and vitamin/mineral blood test. My ferritin was 117 (12-300) and serum iron was 9 (10-30) so my GP recommended I supplement with iron which I did. In the meantime I researched on the Internet and found that normal to high ferritin with low iron could be a sign of anemia of chronic disease and shouldn't be supplemented as the root cause of inflammation needs to be treated. I stopped the iron and asked for another test some weeks later which came back ferritin 181 and serum iron 25. I'm now really concerned as my ferritin is above range for a woman. I'm still struggling with fatigue, aches and hair loss and don't know where/how to start looking for inflammation. Has anyone been diagnosed with ACD or know how to identify and treat it properly? My GP listens to me but has no idea what yo do about my condition. Any advice would be greatly welcome. TIA

22 Replies


It's not something I am familiar with but this link may help you

Thanks Clutter for your reply. This is the site I originally read about ACD. unfortunately there isn't much info online re this condition.

I am also in a similar situation to you - low serum iron, low iron saturation (transferrin) and normal ferritin. I have very recently been given iron tablets also, from the GP, because I have been concerned with how low my iron levels have been over a period of time, and symptoms of palpitations, tiredness, chest pains and fatigue (that I have had for years). This was ignored for years. When I queried that my ferritin result will possibly go too high with iron tablets, he told me to ignore this and to build up the other levels and to go on how I feel. Whether this is correct or not I don't know. Hopefully someone more knowledgeable will be along shortly.

Rebekah40 the link provided by Clutter is very informative and well worth reading. I also have palpitations but put them down to the change and now wondering whether they are also caused by the ACD.

Thanks limasog, I've read this before, you're right it's very informative. I have queried my iron levels with the GP & Endocrinologist for some time and none have really been that interested. I think the idea of giving the iron tablets was a last resort situation. It's very confusing as I have read that in this kind of situation you should not be given iron tablets. I decided I would take them for a short while and see if they made a difference, but am concerned that no-one is interested in what may be causing the issue in the first place. Have you had a celiac disease test to rule that out? I have had 2 and they both came back negative. I have gone gluten free to see if it makes a difference to the hashimoto's and therefore maybe it will help with the iron. It is difficult because I have suffered with fatigue since being a teenager, along with the chest pains and palpitations.

Rebekah40, I have had several celiac tests in the past and all were negative. I've been gluten free for a couple years now which helped me with my brain fog, acid reflux and carpal tunnel. My main concern is that these results could be a sign of something serious and my GP doesn't have enough knowledge to help. I've had terrible sugar cravings since the beginning of the year and think I may have a gut issue or candida but I don't know whether either of these would show as an inflammation in the body. I hope you find a treatment that works for you and are able to get rid of your symptoms.

Thanks limasog. Yes, I agree with you on your concern as it seems to be a difficult one that the GP's don't seem to have much knowledge on. Yes, I have also thought about candida. I hope you also find a treatment :)

I'm now really concerned as my ferritin is above range for a woman.

Just out of curiosity, what do you think the reference range for women is?

When your ferritin was 181 with a reference range of 12 - 300, your result was 58.7% of the way through the reference range. This hardly seems to be a worrying level to me. Or have I missed something?

My reference range is 12-300 but it doesn't differentiate between men and women. As far as I'm aware ferritin upper reference range for women is 150.

You might find this article of interest :

If you think you have been given the wrong reference range you should check it, otherwise you are possibly just worrying for no reason.

Just a little anecdote :

A few years ago I had a few ferritin tests.

Test 1 result 21 ug/L (13 - 150)

Test 2 result (6 months later) 67.7 ug/L (13 - 400)

Test 3 result (8 months after test 2) 41.5 ug/L (13 - 150)

Another way of looking at the above results :

Test 1 was 6% of the way through the reference range.

Test 2 was 14% of the way through the reference range.

Test 3 was 21% of the way through the reference range.

I was supplementing all the way through. Test 2 had a different reference range than the other two but it fitted in with a smooth progression as my results improved when you look at how far through the range it was as a percentage. I don't think the second range was wrong. It was just different.

By second guessing the lab and thinking that they got it wrong by giving you a male reference range I think you are jumping to conclusions and worrying yourself for no reason. But to put your mind at rest you really should double-check the range you've been given.

I wasn't necessarily stating my lab had given me an incorrect reference range but that they didn't distinguish between men and women with regards to ferritin reference ranges. This article has really confused me now as, as far as I was aware, an optimal ferritin result was between 80-100 and the upper reference for women was 150. My main concern is that if I did supplement iron then my ferritin will increase even more and it may still be due to inflammation I have in my body. This is all so confusing and it's really stressing me atm.

Some useful links :

Be aware that it is possible to have more than one kind of anaemia. For example you could have anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA) together. ACD pushes ferritin up and IDA pushes it down. So you could be very ill with both conditions and have perfectly normal ferritin.

When you get tested in future, make sure you give up any iron supplements 5 - 7 days before testing. Also have the tests done first thing in the morning having fasted overnight. The only thing you can have before testing is water.

Thanks humanbean for the links. How would I know if I had both ACD and IDA? I stopped taking the iron supplement more than a week before the blood test but I didn't fast. I'll make sure I do next time.

Unfortunately, I don't know any way of definitively identifying different kinds of anaemia when two kinds occur in the same body. But the more information you have the better chance you have of making some good guesses.

When I was suffering from anaemia I paid for a full iron panel and a full blood count five months after I started supplementing. It helped to narrow things down a little bit but I was still working on a balance of possibilities as to what I might have.

For example, I had several signs of iron deficiency anaemia (low in range serum iron, ferritin, RBC, haemoglobin, haematocrit) but I also had under the range TIBC and low in range transferrin which suggested I also might have ACD.

I was lucky though. I knew why I was anaemic. (I had a gastro-intestinal bleed which wasn't fixed for a very long time.) So making the decision to supplement with iron wasn't a difficult one.

The table at the bottom of this page is very useful (same link I gave you earlier), but only if you have enough information :

But if you have a ferritin level and not much else then it is no help at all. Sorry I can't offer anything more specific.

Hi limasog you mention inflammation. I was wondering if you had had ESR and CPR tested to check for levels of inflammation.

Cheers Skeeter

Yes Skeeter I had CPR tested but not sure about ESR. Do they need to be tested together?

The CPR and esr tests are both inflammation marker tests . The CPR test has a short half life ( I think 19 or so hours )and is used to monitor acute inflammation. The ESR test is good for monitoring chronic inflammation .

I have been looking into it as my wife has just had blood results showing low heamaglobin low heamacrite and a healthy level of ferritin. Her ESR was very high . Just had a retest do are awaiting results .

I'll have to ask whether I had ESR test done this time. My FBC results were all well within range.

I agree with what Humanbean said in an earlier reply . Your Ferritin and serum iron look fine now and are not over range . Hopefully after iron supplementation you will begin to feel better.

Best wishes Skeeter

Thank you Skeeter. I hope so.

Can I ask limasog how your blood tests showed you have ACD rather than iron deficiency?

Strawberrysorbet, the normal ferritin with the below range serum iron led me to believe it could be ACD. With iron deficiency the storage iron would also have been low or below range. I have never supplemented iron prior to now and my iron and ferritin results have been well within range the last few years.

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