On behalf of HowNowWhatNow, can anyone explain low ferritin, high Hb

[Noelnoel]

HowNowWhatNow

Not sure how well this will go HowNow because all replies will come to me

[HowNowWhatNow]

Noel Noel has posted this question on my behalf.

After a long-running history of extremely low ferritin and also of low HB over many years, recently treated permanently by means of an endometrial ablation - I now have low ish FE levels and high HB levels.

This means I don’t know whether to take my Three Arrows iron supplements, on a practical level. (I have stopped). But also, I don’t know what this means.

If I wait, will the FE catch up with the HB? Or does the process work the other way around? Will HB track down to meet FE?

I know that HB can be a marker for inflammation so these numbers aren’t as 100% clear cut as all that. Assuming inflammation is not a problem here - I have no reason to believe it is - what practical steps can I take to raise ferritin levels? Or do I sit tight?

Thank you

[FallingInReverse in reply to HowNowWhatNow]

When you say “FE” you mean serum iron, right?

Can you share your exact numbers - when you say hi, and low, what the result is.

What iron-related and inflammation-related blood tests have you had, can you share the results?

And what has your iron supplementation history been?

[HowNowWhatNow in reply to FallingInReverse]

I actually mean Ferritin. I know FE is the periodic table element for iron, but I use it as an abbr for ferritin in this case.

My iron supplementation history is extremely lengthy and bumpy. It all led to lots of major side effects. Ultimately I had to supplement using iron infusions as nothing agreed with me, and oral iron supplements had wrecked my gut and caused other brand new issues (and I hadn’t found the US brand of iron that avoids these). Then I reacted badly to an iron infusion and could have no more. I had my last iron infusion in June 2023. I then had my endometrial ablation in December 2023. I started taking 3 arrows iron in late 2023, but stopped in early 2024, when I saw that my HB level was above normal.

[HowNowWhatNow in reply to HowNowWhatNow]

Am looking after 2 sick kids now, will reply with numbers when I have a moment. Thanks.

[FallingInReverse in reply to HowNowWhatNow]

Good luck with the kiddies!

Quick thoughts - share your results whenever you can.

HB and ferritin are not direct measures of iron, and so interpreting them depends on knowing the things that go into making them, your results trends and your supplementing.

For example, ferritin as your storage iron may deplete first when your body senses iron is needed. So it will be used up to keep the other active iron functions afloat. Maybe.

HB of course will rise faster than the slow-as-molasses ferritin. So supplementing will play a part there. Or if HB is high and other indicators show low, and it’s not a lagging response, then it could possibly reflect dysfunction in how your body uses iron. Ie, you might have seemingly enough in certain places, but it’s not getting used effectively and so other measures will be low. Your varied history hints there might be something to this but no idea : )

But also, hemoglobin is not a direct measure of iron. (Actually, ferritin isn’t either…) Both are proteins… and yes, they depend on adequate iron for sufficient levels. But they are not iron. HB it is the protein that carries oxygen through your blood. Iron is needed to make HB (each contains iron which the oxygen binds to).

That’s why iron panels include iron, TIBC, transferrin saturation as a picture of iron health, in addition to iron stores measured by Ferritin, plus inflammation to interpret the ferritin.

[radd in reply to HowNowWhatNow]

HNWN,

HB is influenced by available iron (as in serum) and not directly from ferritin (storage). I guess if you are now losing less blood, more serum iron will be available for erythropoiesis.

Also thyroid hormones need iron for best synthesis so usage of meds might have improved. They have a strong influence on both production and gene expression of haemoglobin with higher levels increasing globulins and lowered levels reducing. Same with RBC’s.

Maybe ferritin will follow now actual iron levels should remain more consistent, but if you have Hashi there’s usually a certain amount of systemic inflammation.