Just came across this on PubMed. It may be 'old' news, but I wasn't aware of it myself so it may be of interest to some of you.
ncbi.nlm.nih.gov/pmc/articl...
Hopefully someone can pick over the bones and come up with a view as to whether this might explain why many of us develop anemias of various sorts.
Hidden , what an interesting paper and very interesting to me at the present time. Thanks for posting.
Very interesting - thank you .... Another piece of the jigsaw for some.
Very intersting, Cassie, thank you for posting. Quite relevant to me as not one single haematologist has been able to explain why my RBCs have been well above range for a few months, while feeling o weak, so ill and they still persist in saying I am not anaemic... and ignore my very low iron level, well below range. I am hypothyroid as well as having rheumatoid arthritis. They say I have CFS(chronic fatigue syndrome) because they are unable (and not prepared to try and do more research I suppose) to find the cause of my on-going exhaustion... and refuse to give me an iron infusion because Hb and Ferritin within rane... whilst iron is incredibly low, even saying they don't take any notice of iron level!!! Really? If you know of any decent haematologist who could help pleas let me know by PM. Thanks.
If your Hb and Ferritin are in range and your serum iron is very low, it is possible you have an infection of some kind, and a condition as a result called Anaemia of Chronic Disease or Anaemia of Chronic Inflammation. How and why this happens is described in the following two links :
irondisorders.org/anemia-of...
irondisorders.org/Websites/... (see page 8 in this link)
For summary info on lots of different kinds of anaemia :
irondisorders.org/Websites/...
Another possible cause of low serum iron and in-range Hb and ferritin could be a chronic gastro-intestinal bleed, perhaps caused by bleeding polyps, piles or cancer. You would need to ask for a faecal occult blood test, but for accurate results of such a test, please read this post :
healthunlocked.com/thyroidu....
Humanbean,
Many thanks for contacting me and indicating the links. I will need to read everything carefully, download them and try and find someone really intelligent (not just a doctor who limits his/her knowledge to their spcialism without taking into account the patient's whole medical history) in the hope I can get some help.
I am so scared, so worried as am getting physically weaker. The problem is I don't know how I can find such a medical professional who could investigate further and hopefully give me the chance to feel better, more able to cope.
Am recovering well from a total knee replacement operation (11 December last year) but this exhaustion is holding me back. am still in a care home to allow me to recover as i would not have been able to cope alone at home, feeling so weak. If it were not for such an exhaustion, i feel I would be able to return home very soon. The haematologist I saw (the second one) told me they do not take notice of iron levels... How bizarre... and ending saying she feels I have CFS (chronic fatigue syndrome), something many doctors say when they are unable to find what the problem is.... so it's like pushing someone into a corner with little hope of getting better and they wash their hands of the situation. One less to be concerned about. It depresses me and worries me.
I wonder whether you or anyone else would know who I should consider seeing to help me, what hospital in the UK would be best to deal with such a difficult health matter? I really do not know where to go from here, who to ask, having tried so much to find a way forward and always hitting my head against a brick wall. Feel desperate.
My serum iron was 3 umol/L (8.8 to 27) on 15/12/17. Ferritin: 152ng/L (30-400)
Serum transferrin level : 2.10 g/L (2-3.2)
transferrin saturation index:8% (20- 40)
Hb concentration on 5/12/17: 122 g/L (120-150)
MCH level: 26.9 pg (27-32)
Mean cell volume: 83 fl (83-101)
Haematocrit: 0.376 (0.36-0.49)
Total white blood cells: 9.35 10*9/L (4-10)
RBC: 4.53 10*12/L (3.8-4.8)
Platelet: 326 10*9/L (150-400)
Neutrophil: 7.77 10*9/L (2-7)
Lymphocyte: 0.79 10*9/L (1-3)
Thanks again for responding and the links.
I'm afraid I don't know the names of anyone you can see. I don't have any medical training. But your results are clearly appalling, and I'm not surprised that you are very weak.
SeasideSusie greygoose SlowDragon Clutter helvella
Do any of you have any suggestions for this member?
The only things I can suggest are that you :
a) Ask your doctor for a bowel screening test because of your very low iron. Make sure you follow the suggestions in the healthunlocked link I gave above to avoid false negatives or false positives.
b) Start eating liver a couple of times a week.
c) Start taking iron supplements - there are various different kinds. They can be bought in pharmacies without prescription or can be bought online. Helvella has produced a document on the ways that iron can be supplemented.
dropbox.com/sh/3waycnbzhywi...
d) The kinds of iron supplements that would be prescribed if a doctor actually prescribed them are listed down the right hand side on this page :
bnf.nice.org.uk/treatment-s...
You can click on each name in the list for more info on types and dosage. I improved my own iron with 1 ferrous fumarate 210mg, 3 times a day. I took each tablet with 500mg - 1000mg of vitamin C which helps the body absorb it, and also reduces the risk of constipation caused by iron. I bought my iron from pharmacies in the UK without a prescription.
I tested my iron levels fairly regularly by paying privately for my own testing :
medichecks.com/iron-tests/i...
medichecks.com/haematology-...
It took me nearly two years to raise my iron levels fairly close to optimal.
e) One thing I will say though, is that supplementing iron without knowing why your levels are so bad seems like a risky thing to do. When I was supplementing I knew that my levels were so poor because I'd had a gastro-intestinal bleed caused by a large polyp for several years. Once the polyp had been found and fixed (and it took an astonishing length of time for the medical profession to find it), I fixed the deficiency myself.
f) Sorry I can't make any specific suggestions.
I forgot to mention...
For doing your own research into blood test results this website is useful :
It used to be easier to understand and navigate than it is now. They've changed it in recent months and I don't like the new version. *Sigh*
Sorry, I have little understanding of iron. It seems so complicated. But, I would have thought, JGBH , that you should be seeing a gastroenterologist for a complete examination of the digestive tract.
Refuse to accept the 'diagnosis' of CFS. It is a syndrome, and you can't diagnose anyone with a syndrome, anymore than you can a symptom - well, a syndrome is a bunch of symptoms, and something must be causing them. And, I would have thought, it is your doctors' job to find out what. 
GG, I had an endoscopy last year and gastro diagnosed reactive gastritis and iron deficiency for which I have been taking iron fumarate 322mg, 2 tablets/day during which time my iron level dropped very low. So have stoped taking iron (also was very constipated... feelig so sick) but NOT anaemia! Here we go again... It seems anaemia is the magic word for them, but they always say everything is "normal" even if the results are close to bottom of accepted range... How to make such narrow-minded people look at problems in a lateral way? They seem unable to look at a patient as a whole, looking at all the health issues and try to correlate things. Everything is in a "box" which they conveniently tick and as far as they're concerned Job done! but patient still suffering.
As for CFS I have accepted to go to the clinic just to see what they actually do... but will definitely tell my GP I want further investigations. However, it's going to be rather difficult since I have had quite a few investigations and as far as they are concerned it's always OK... but they take no notice that the patient is left feeling so vvery unwell... as far as they're concerned they've check the basic things and it comes out ok so they don't see the point of investigating further until they find the real soure of problem. They don't want to know. I truly despair as don't know where to go next, but I know I simply can't carry on like that. It's not living...
I totally agree with you in all you say about the medical profession. And, they only seem to care about things that are profitable to them. I really don't know what can be done about it. They are not worthy of the name 'doctor'!
What I found quite revealing is that the haematologist was telling me I should not have B12 injections, 3 times/week. That she would not have prescribed it.... because there's no evidence that it helps... told her the evidence was the improvements I felt (tinnitus stopped, recovered my balance, could feel my toes again, etc) but she would not have it. Reciting the Hyppocratic oath: "do no harm"... and in the same breath stating that my GP had to prescribe B12 "outside the British haematology society" and therefore if something went wrong with me she would be in trouble... So told her that because of the lack of treatment many people bought their B12 injections from Germany in order to stop their misery... Do you know what she said? Well, sit down. She said she had no problem with that! What an hypocrite... all she was concerned about was covering the doctors' back... and to hell with the patients...and she dared quote the hyppocratic oath "do no harm"! The friend who was with me was stunned. So it looks like she was only intereted in seeing me in order to stop my B12and had no interest in my feeling so weak, so ill. What a useless lot! What can patients do against such a lack of care?
HB,
Thank you so very much for the care and time you have taken in trying to help me, I appreciate it greatly and it is a source of support when I feel so low at all levels.
I have had an endoscopy about a year ago and was diagnosed with erosive gastritis (had that for a very long time and taking PPIs for decades). Also have hiatus hernia. Was also diagnosed with iron feficiency for which I took iron fumarate 322 mg. 2 tablets/day. First of all the iron level- which was low but within range then - went up a little and ferritin went up marginally. Then in November last year my iron level dropped to 4 (8.8-27) and then on 15th December, 4 days post operation, it dropped further to 3. I have been and am still very constipated (I took VitC) so decided to stop taking iron 10 days ago. Obviously I can't absorb/fix iron, for whatever reason. The useless haematologist also said to stop taking iron... but no solution! She was most concerned about stopping me having 3 B12 injections/week! Incredible... ! I wonder if they actually don't want people over the age of 65 to be treated... and be well.
As you mention in e) section of reply I am not sure I should take anymore iron at the moment as it could make matters worse, without knowing WHY my iron level is so low. The problem is I don't know what to do now, where to turn... But I know I MUST have help as I truly feel I am dying slowly, unable to live a little, do basic things, just cope with everyday life as i used to and am only 71 not at the end of my 80s when it is probably more difficult to look after oneself then. It makes me feels so much older and that I have reached the end of my life. Am a strong minded person but this is affecting me now. Have had 3 rough years whereby my health has deteriorated gradually and it's scary. Clearly I need help, a decent doctor who is prepared to correlate everything and find a solution, but WHERE will I find such a person?... Will need to have yet another very difficult conversation with GP soon. But will I get anywhere?
You mentioned you had a large polyp. From endoscopy done a few years ago they said there was a "small polyp" (but I've realised they tend to make things "smaller" than they are... and of course polyp was still showing on last year's endoscopy. I wonder whether it has been bleeding. I have felt pain at the place where polyp is supposed to be. Did you feel pain when you had yours? How did you manage to convince gastroenterologist it should be removed? I just feel I have been fighting for so many years with little result and hitting a brick wall all the time. I did then tell the gastro I would like the polyp to be removed... he said not necessary! it does seem they wait till it get so bad, turns into cancer before they do anything. No idea about prevention. It worries me of course.
I was eating liver (not a fan) when at home. Am amazed how bad, that is not very nutritious and full of satuated fats and sugar the food is in the care home.... I did make a list of food types i would not eat before I came in, so my food is a little better but not that much. Luckily friends bring me some healthy food and plenty of fruit, but the fees are quite high and that should not be necessary. When I was offered tinned chicken soup one evening I suggested they make some fresh vegetable soup (not that expensive to do and not difficult to make) I was told "They would not eat here here"....well, that says it all! Old people can be fed rubbish.How sad is that. I can't wait to go home... but the weakness is a problem. My eyes have been opened as to how old people are treated and it's not great.
So many thanks again HB for all the good advice and support.
Hello JGBH, apologies for the delay in getting back to you. My husband has recently died and I have been rather taken up with 'other' things. I am glad you found the articles interesting, I certainly did. I have hashimoto's and PA and had macrocytic anemia (high MCV) as opposed to your microcytic anemia (low MCV) so I don't know if I can offer too much in the way of advice. I am not medically trained in any way but do a lot of reading.
I have read a few of your posts but cannot gather whether you have been tested for celiac disease, if you haven't it might be a good idea to rule this out as it can result in severe malabsorption of nutrients (you probably know all this). Microcytic anemia will certainly make you feel tired as the small cells won't be able to carry enough oxygen.
The other thing that comes to mind is that prescription medications will rob your body of nutrients and it may well be that you have become deficient by this route. There are around 90 nutrients needed by the body and everything works together. Iron, like most other things, needs cofactors to work and be absorbed efficiently such as Vitamin A, C, copper (taken with zinc), biotin and riboflavin. This is a link about Vitamin D and iron, you might find it interesting:-
anemiacentral.com/vitamin-d...
I have never seen a haematologist so not able to offer any suggestions, sorry.
Good wishes,
Cassie
HelloCassie,
So very sorry about your recent loss. Please accept my sincere condolances and empathy. I unederstand how very busy you must have been and really there is no need for you to apologise for the delay in replying. Nevertheless, thank you so much for caring to reply when you have had so much to sort out and do.
The problem is that all medics insist I do not have anaemia!!! They think my haemoglobin and ferritin levels are good (although Hb near bottom of range)... but they're happy with that. Obviously they do not suffer the consequences of feeling so unwell and unable to cope. I am really upset and despair at such incompetence from medical professionals. I need to find a way forward, but am losing hope... have tried so hard for so long but no success. I hit a brick wall evert time. It feels like a conspiracy... of not wanting older people who have complex health issues get better (am 71).
I have been told by a gastro I do not have coeliac disease. I have difficulty in absorbing nutrients although I have a good diet, Have erosive gastritis (had it for years because of taking so many drugs, especially NSAIDS which I have s topped using now), have gastric reflux (quite badly), a hiatus hernia (for years) and consequently have been on Nexium (omesprasole) for decades... so my absorption of good nutrients must be pretty difficult! Have B12 deficiency which has not been officially diagnosed, but have B12 injections 3 times/week. There again useless haematologist wants me to stop that! I really wonder why they're paid so much to be so mediocre at their job! I feel confident that if they or their family were ill they would do all investigations necessary - refused to most patients - and would follow with a treatment at no cost spared. The usual rule of them against us... These doctors have too much power over our bodies, Of course there are excellent doctors, but one has to be lucky to find them...
I have rheumatoic arthritis (had it since 1980s) and had thyroid papillary adenocarcinoma (1980) so take levothroxine since then. I have biologic injections, once/week for RA (Enbrel).
I still feel doctors should not give up so easily when a patient present with serious symptoms of exhaustion (used to faint quite often, 2 years ago, even while sitting down... and yet nothing was being done. Sorry about the moaning but I have enough...
Thanks again and take care.
Hello JGBH, I can well imagine how you feel and how difficult it is to know which way to turn next. I gave up on doctors a while back, haven't been for around 4 years now when a neurologist suggested I need anti-depressants. My numb toes, tingling in legs, speech problems et al were all attributed to a deficiency in anti-depressants - who would have guessed that!!!! As far as I am concerned my body is smarter than any doctor and if it says I have numb toes, tingling etc, then that's what I have - antidepressants are a 'cop out' designed to dumb you down.
I know you have complex health problems and I am not really in a position to comment or offer advice on the best way forward. However, I am aware of the huge importance of a healthy gut to enable you to absorb nutrients from your food, erosive gastritis must be so painful. Personally I would try first to heal my gut. The one thing your gut needs is an acid environment to enable it to break down and use the nutrients in food. Doctors frequently diagnose acid reflux as too much acid when it fact it is too little, if your doctor misdiagnosed yours, Omesprasole will exacerbate the problem and in any case should only be used for short periods of time if he got the diagnoses right. As your gut is so inflamed I am not sure how it would react to something like Betaine HCL before a meal, digestive enzymes might help also along with probiotics, sauerkraut, live yogurt, small more frequent meals and foods which don't make the stomach work too hard while its healing.
Omesprasole can deplete the body of B12 and magnesium, Enbrel can deplete the body of folic acid and Levothyroxene can deplete iron.
I am not suggesting you should stop taking your medications, just be aware that prescription medications can also contribute to nutrient loss.
I really wish you well.
Cassie
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