Low iron?

About six years ago, my docs noticed that my hemoglobin was low, so I underwent iron tests which showed my iron low. After I "passed" an endoscopy and colonoscopy, I was told to take iron supplements, which I did until my tests were normal--a few months, as I recall.

Now the same thing seems to be happening. This week, my iron was 22 (normal 35-160), and my ferritin test was also very low. The info I read gives the main causes of such iron deficiency (in post-menopausal women) as ulcers and colon cancer, which is why I had the endoscopy and colonoscopy before.

A few months ago, I had a massive nose bleed, but other than that, I've noticed no bleeding anywhere. Has anyone else had this low iron problem? I know most ITPers don't have it, but could there be some connection between ITP and low levels of iron?

Karen, Have they been able to identify the kind of anemia you have?
For example, Common causes of pernicious anemia are:
•Weakened stomach lining (atrophic gastritis)
•The body's immune system attacking the cells that make intrinsic factor (autoimmunity against gastric parietal cells) or intrinsic factor itself

For Hemolytic anemia:
Hemolytic anemia occurs when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells. If the bone marrow is able to keep up with the early destruction, anemia does not occur (this is sometimes called compensated hemolysis).
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There are many types of hemolytic anemia, which are classified by the reason for the premature destruction of red blood cells. The defect may be in the red blood cell itself (intrinsic factors), or outside the red blood cell (extrinsic factors).

Intrinsic factors are often present at birth (hereditary). They include:
• Abnormalities in the proteins that build normal red blood cells
• Differences in the protein inside a red blood cell that carries oxygen (hemoglobin)

Extrinsic factors include:
• Abnormal immune system responses
• Blood clots in small blood vessels
• Certain infections
• Side effects from medications

Megaloblastic anemia is a blood disorder in which there is anemia with larger-than-normal red blood cells, and is usually caused by a deficiency of folic acid or vitamin B12.

Other less common causes are:
• Alcohol abuse
• Certain inherited disorders
• Drugs that affect DNA, such as chemotherapy drugs (perhaps Rituxan side effect?)
• Leukemia
• Myelodysplastic syndrome
• Myelofibrosis (not sure, but might this be a side effect of Nplate or Promacta?)

Aplastic anemia:
In people who have aplastic anemia, the body doesn't make enough red blood cells, white blood cells, and platelets. This is because the bone marrow's stem cells are damaged. (Aplastic anemia also is called bone marrow failure.)

Many diseases, conditions, and factors can damage the stem cells. These conditions can be acquired or inherited. ("Acquired" means you aren't born with the condition, but you develop it. "Inherited" means your parents passed the gene for the condition on to you.) Damage to the bone marrow's stem cells causes aplastic anemia. When stem cells are damaged, they don't grow into healthy blood cells.
Many diseases, conditions, and factors can cause aplastic anemia, including:
• Toxins, such as pesticides, arsenic, and benzene.
• Radiation and chemotherapy (treatments for cancer).
• Medicines, such as chloramphenicol (an antibiotic rarely used in the United States).
• Infectious diseases, such as hepatitis, Epstein-Barr virus, cytomegalovirus parvovirus B19, and HIV.
• Autoimmune disorders, such as lupus, ITP and rheumatoid arthritis.
• Pregnancy. (Aplastic anemia that occurs during pregnancy often goes away after delivery.)

Sometimes, cancer from another part of the body can spread to the bone and cause aplastic anemia.


So, it appears to me that many types of anemia are due to an auto-immune response. Having a history of any auto-immune response, either in yourself or your family, will make you more susceptible to other auto-immune problems.

Also, it appears that various medications or treatments might possibly contribute to certain types of anemia.

Karen:

I have low ferritin and take an iron supplement. My daughter also has low ferritin. I don't know why people with autoimmune disorders tend to have other things that are low like that, but it seems common. When I found out about the low ferritin, ITP had been in remission for a few years and my daughter doesn't have ITP, so I think it's autoimmune in general or, just a general population problem.

Thank you, April and Sandy, for your responses. My CBCs seem to show that my red and white blood cell counts are okay. My doctors will have all my lab results on Tuesday, so perhaps they will specify what kind of anemia I have then. The last time I had low iron and ferritin, I don't recall the doctors naming the anemia; they just ordered the endoscopy and colonoscopy and, when they both proved negative, prescribed iron supplements. My only prescription med that I take regularly is prednisone (currently 3 mg, but that will probably rise soon--usually fairly low doses though). My platelets were 35K last week though I had enjoyed counts in the 60s, 70s, even 80s for a couple of unusual months before that.

I also have low ferritin, and taking a prescription Iron supplement. Not sure why it is low. Going to have it checked again.

For Sandi and Dean and anyone else who has taken an iron supplement like ferrous sulfate:

Did you have any side effects from the iron supplement? And how much do you take?
I took one pill ("equivalent to 325 mg ferrous sulfate") on an empty stomach (as was suggested) and started feeling woozy about an hour afterwards. I took another one at night, this time on a less empty stomach (citrus, which is supposed to help iron be absorbed). I felt a little dizzy all night and this morning quite dizzy and somewhat nauseated--things clearly not right. I note the possible side effects listed for iron supplements include these symptoms. I don't remember anything this severe, however, the last time I took supplements for mild iron-deficiency anemia, in 2004.

I suppose it's possible I have some other sudden-onset ailment, but the timing makes me think the supplement is responsible.

Karen - I'm not the one to ask. I take so many meds - about 14 scripts and 4 non-scripts and I really can't sort out what gives me what side effects any more or what are Lupus symptoms.

Karen, I am also taking Ferrous Sulfate. It is best taken on an empty stomach, with a full glass of water, 1 hour before or 2 hours after a meal. If stomach upset occures take with food. I am sure you already know that. Also avoid antacids, dairy products, tea and coffee 2 hours after taking, as these reduce it's effectiveness. Do not lie down for 10 minutes after taking. I take one 325mg twice a day. I try to do it on an empty stomach so I get the most benifit from it. If I drink plenty of water it does not bother me. May want to consider a lower dose OTC Iron supplement. The OTC has Ferrous Sulfate in it. I have seen OTC Iron supplements in 27mg pills. Maybe the lower dose will be kinder to you. To much Iron is not good either.

Sandi, you pretty much have a pill cocktail everyday. Are some pills to counteract other pills.

Ha, cocktails for breakfast, lunch, dinner and before bed. Only two of them are to counteract other meds.

4 squares a day, huh. Hope I never have to rely on so many Meds!!!

THanks for info, Dean. I have worked myself up to one of those pills (325 mg ferrous sulfate) a day--I tried a half a pill for a few days. Maybe next week my body will have adjusted so I can increase to 1-1/2 and eventually 2, which is what my doctor prescribed. I'm having to take the pill with food, or just after I eat. I feel a little yucky afterwards, but I can deal with a little yuckiness!

Hope it helps!!

I also have ferritin then my doctor suggest me to take iron supplements to boost the low levels of iron in the body and today I fully recovered from this problem.

wjames wrote: I also have ferritin then my doctor suggest me to take iron supplements to boost the low levels of iron in the body and today I fully recovered from this problem.

Good to hear!!

april wrote: • Drugs that affect DNA, such as chemotherapy drugs (perhaps Rituxan side effect?)

Someone - April, Joan, anyone - is Rituxan a chemotherapy drug???

No, it's not.

Rituxan has been referred to as a bio-therapy. Not chemo.
Erica

I'm no expert on it, but I think that technically, it is not. I have heard many patients and even quite a few doctors refer to it as such, though. Probably as it is given along with a couple of chemotherapy drugs to treat some cancers. It just targets the B cells, killing off that part of your immune system.

But then again, not exactly sure what the definition of "chemotherapy" is...if Rituxan is a chemical and used for therapy ..it's all very confusing to me!

I have read that if you have reacted badly to IVIG, that you will probably have an even worse reaction to Rituxan. Not sure if this is really so or not, but personally, I wouldn't want to chance it.

Since I don't think any studies have been done on every drug out there and how they affect the minerals in your body, it pays to err on the side of caution and perhaps extrapolate from what we DO know.

Yeah, the new world of 'biologicals' or immunotherapies. Enbrel, Benlysta, Remicade,Rituxan, etc.