Biogeek, Please Help!

[LooseShoes]

I went to the doctor today and had some good news. I've lost 30 pounds since I went 3 months ago. My blood pressure was 120/70--before I started Atkins it was 145/85.

Bad news is I'm still anemic. 3 months ago my blood count was 11.4, now it's 10.4. I've been taking a multivitamin WITH iron because I knew I was anemic. I eat quite a bit of red meat, eggs and green leafy vegetables. Background history is that I've ALWAYS been anemic. So have my mother and sister. The only thing that helps my mom is B12 shots, but the doctor won't give them to her very often for some reason. I figure if this was something horrible, I'd have been dead a long time ago.

The doctor wants me to take an additional iron pill on top of my multivitamin. Been there, done that before--makes me feel HORRIBLE. Stomach hurts all the time, constipated then raging diarrhea, last time I started feeling dizzy. I think my body rejects the extra iron. When I was pregnant, both times, the doctor made me take iron on top of the prenatal vitamins. That's been 13 and 17 years ago.

I really don't feel bad, I haven't been sleeping as much and I've been exercising a lot. I felt a little lightheaded yesterday when I did Power 90, but I didn't eat breakfast before. After I ate, I felt fine. The doctor told me I was probably used to running on low iron, but that it still wasn't good for me.

My multi vitamin provides iron as ferrous fumarate 18 mg. The pharmacist recommended me to take Ferro-Sequels 50 mg Ferrous fumarate.

I guess my questions are:
What is a normal and low blood count number wise?
Am I at a dangerously low level?
Is there anything besides these awful iron pills that I can do to make this better?

Thanks so much for any help you can provide!

I'm just really frustrated because I know I've been doing all I can to get my anemia under control and I don't know what else to do.

[jimmie 48]

Re: Biogeek, Please Help!

bio, would age (sorry caryl, i'm in the same boat but my sailed before yours ) have anything to do with this?

[LooseShoes]

Re: Biogeek, Please Help!

Well, I've been anemic since I was a kid--in fact I had what they call pico (sp?) where you eat weird stuff like dirt. What I did was "wash" rocks in my mouth. For some reason the dirt tasted good. My sister says it was her job to get the rocks out of my mouth before we went anywhere. I swear I don't do that anymore! I was under 5 yo at the time. I do chew ice though, and I've heard that that's a sign of anemia. Doesn't particularly please my dentist, either.

Thanks for bringing up my age, Jimmie! I just love when doctors say "Well, we don't know what causes it, but sometimes women your age have this problem." Makes me want to kick them in their teeth! That was said about my iritis, though, not iron problems. I asked them if taking the steroid eyedrops for 6 weeks would cause this and they said no.

I'm so confused!

[mitzimarie]

Re: Biogeek, Please Help!

Hmmm... this may be far-fetched, but would you happen to be of Mediterranean descent?

I am half Italian, and I have something called Thalassemia. (not sure if I spelled that right). It is a type of anemia that affects some people of Mediterranean descent. It is passed down in the genes. My mother has it, I have it but neither my brother nor sister do. We have discovered that my 11 year old son has it, too.

I think that there are different degrees of Thalassemia, but what I have learned about mine is that eating all of the extra iron in the world would not change my levels on a blood test... my body just doesn't process it or something, and has adjusted to this so there are no ill effects from having this genetic type of anemia except that I cannot give blood. I was just diagnosed with this in the last 10 years... prior to that, I had doctors shoving iron at me like it was going out of style, but it never helped my counts. So now whenever I have blood work done, a note is made that I have Thalassemia and no one freaks out over the numbers.

Do you know the test name for the numbers you asked us about? The reason I ask is because I have a copy of my blood work in front of me and it lists the ranges for each of the tests, but I don't know which of these tests your numbers go with. There is a group of tests that the doctor made a note next to about my anemia, so I'm not sure which one is right. Is it HGB maybe? My result was 12.2 and the range is 12.0 - 16.

[kisstuck]

Re: Biogeek, Please Help!

3 months ago my blood count was 11.4, now it's 10.4.

I guess my questions are:
What is a normal and low blood count number wise?
Am I at a dangerously low level?
Is there anything besides these awful iron pills that I can do to make this better?

I'm not a doctor, but I am an ER nurse. I can help shed a little light for you. Do you know what type of anemia you have? There are several types and sometimes knowing what type can help you plan your attack so to speak. Also knowing the type of anemia can rule out other causes of blood loss such as blood in your stools (microscopic- you don't see it, they have to do a hemocult test to check for it) Iron deficiency anemia can be associated with low dietary intake of iron, inadequate absorption of iron, or excessive blood loss.

Iron deficiency develops gradually and usually begins with a negative iron balance, when iron intake does not meet the daily need for dietary iron. This negative balance initially depletes the storage form of iron while the blood hemoglobin level, a marker of iron status, remains normal. Iron deficiency anemia is an advanced stage of iron depletion. It occurs when storage sites of iron are deficient and blood levels of iron cannot meet daily needs. Blood hemoglobin levels are below normal with iron deficiency anemia.

The normal level of hemoglobin for an adult female is between 12 and 16. Many things can affect this number. One of the major factors is hydration. You may have been less hydrated 3 months ago and that caused the number to be more than the current number.

You are not so low that you need a transfusion or anything. Your doctor is right in wanting you to take a supplement. I, too, feel awful if I have to take iron. Most physicians won't transfuse an asymptomatic person who's hemoglobin level is above 8. (Give or take a little depending on the doc)

Highest amounts of iron from animal sources:
FoodMilligrams
per serving% DV*Chicken liver, cooked, 3½ ounces12.870Oysters, fried, 6 pieces4.525Beef, chuck, lean only, braised, 3 ounces3.220Clams, fried, ¾ cup3.015Beef, tenderloin, roasted, 3 ounces 3.015Turkey, dark meat, roasted, 3½ ounces2.310Beef, eye of round, roasted, 3 ounces2.210Turkey, light meat, roasted, 3½ ounces1.68Chicken, leg, meat only, roasted, 3½ ounces1.36Tuna, fresh bluefin, cooked, dry heat, 3 ounces1.16Chicken, breast, roasted, 3 ounces1.16Halibut, cooked, dry heat, 3 ounces0.96Crab, blue crab, cooked, moist heat, 3 ounces0.84Pork, loin, broiled, 3 ounces0.84Tuna, white, canned in water, 3 ounces0.84Shrimp, mixed species, cooked, moist heat, 4 large0.74

Highest amounts of iron from plant sources:
FoodMilligrams
per serving% DV*Ready-to-eat cereal, 100% iron fortified, ¾ cup 18.0100Oatmeal, instant, fortified, prepared with water, 1 cup10.060Soybeans, mature, boiled, 1 cup 8.850Lentils, boiled, 1 cup6.635Beans, kidney, mature, boiled, 1 cup5.225Beans, lima, large, mature, boiled, 1 cup4.525Beans, navy, mature, boiled, 1 cup4.525Ready-to-eat cereal, 25% iron fortified, ¾ cup4.525Beans, black, mature, boiled, 1 cup3.620Beans, pinto, mature, boiled, 1 cup 3.620Molasses, blackstrap, 1 tablespoon3.520Tofu, raw, firm, ½ cup3.420Spinach, boiled, drained, ½ cup3.220Spinach, canned, drained solids ½ cup2.510Black-eyed peas (cowpeas), boiled, 1 cup1.810Spinach, frozen, chopped, boiled ½ cup1.910Grits, white, enriched, quick, prepared with water, 1 cup1.58Raisins, seedless, packed, ½ cup1.58Whole wheat bread, 1 slice0.96White bread, enriched, 1 slice0.96

Meat proteins and vitamin C will improve the absorption of iron. Vitamin A helps mobilize iron from its storage sites, so a deficiency of vitamin A limits the body's ability to use stored iron. Chronic malabsorption can contribute to iron depletion and deficiency by limiting dietary iron absorption or by contributing to intestinal blood loss. Most iron is absorbed in the small intestines. Gastrointestinal disorders such as Celiac or Crohn's that result in inflammation of the small intestine may result in diarrhea, poor absorption of dietary iron, and iron depletion.

Supplemental iron is available in two forms: ferrous and ferric. Ferrous iron salts (ferrous fumarate, ferrous sulfate, and ferrous gluconate) are the best absorbed forms of iron supplements.

I am not an expert on this and have told you all I can in an abbreviated version. Maybe Biogeek can let you in on some supplements to help. I hope I have not totally confused you!

[LooseShoes]

Re: Biogeek, Please Help!

Mitzi, I'm not sure if I have Meditarranean blood or not. There are a lot of blank spots in our family tree. My mother's father was "unknown" and my dad's father was an orphan, not much knowledge of where he came from. I'm thinking whatever this is comes from my mom's side, though. I'll ask the Dr about thalassemia, though. Do they do a special test for it? Thanks!

Kisstuck, you're a marvel! They are having me do a hemocult test Monday. I'm not sure they know what kind of anemia it is, they just want to force more iron down me. I'm trying, but I already feel bloated from the one extra iron pill I took today. They're also doing a folate and B12 test, but I doubt I'll hear from that until next month. They're probably not the best doctors in town, but they're what I can afford without insurance and they work with me to pay it out.

Transfusion doesn't sound like something I would do unless absolutely necessary. My parents tried to make me eat liver as a kid, and I would gag until I, how shall I say this, ejected it from my system. I do eat steak several times a week, chicken, tuna, etc.

My vitamins have Vitamin A and C, and I've had virtually no stomach problems since I've been on Atkins.

I'm thinking it's probably more an absorption problem than anything. What I was doing different earlier in the year was taking liquid B-12 in drops under my tongue. I quit taking it because I wasn't sure if it made any difference and I ran out. I may get some more of that and see if it helps. Dr told me I could take the iron every other day. I just can't handle it at all every day.

Thanks for your help, guys, it gives me something to think about. Don't worry about confusing me, I'm already there!

[mitzimarie]

Re: Biogeek, Please Help!

Mitzi, I'm not sure if I have Meditarranean blood or not. There are a lot of blank spots in our family tree. My mother's father was "unknown" and my dad's father was an orphan, not much knowledge of where he came from. I'm thinking whatever this is comes from my mom's side, though. I'll ask the Dr about thalassemia, though. Do they do a special test for it? Thanks!

Caryl, I'm not sure what the test is. On one of the times I gave blood, the lab called me and told me I had it. And in the case of my son - he had to have blood work done before having his tonsils out and when they got the results they asked me if there was a family history of anemia and when I told them that my mother and I had it, they just assumed that was what was going on with my son without testing him further. I will ask my mom to see if she knows anything about testing.

[LooseShoes]

Re: Biogeek, Please Help!

Thanks, Mitzi!

[mitzimarie]

Re: Biogeek, Please Help!

Hi Caryl,

There are different kinds of thalassemia... one is major (both parents carried the trait) and one is minor (only one parent carried the trait). The major kind is serious - I have the minor kind. It is also sometimes called Cooley's anemia, although my doctors use the term thalassemia with me.

Here is something I found on the internet...
How Is Thalassemia Diagnosed?

Thalassemia is diagnosed using blood tests, including a complete blood count (CBC) and special hemoglobin studies.

• A CBC provides information about the amount of hemoglobin and the different kinds of blood cells, such as red blood cells, in a sample of blood. People with thalassemia have fewer red blood cells than normal and less hemoglobin than normal in their blood. Carriers of the trait may have slightly small red blood cells as their only sign.
• Hemoglobin studies measure the types of hemoglobin in a blood sample.

Cooley’s anemia is usually diagnosed in early childhood because of signs and symptoms, including severe anemia. Some people with milder forms of thalassemia may be diagnosed after a routine blood test shows that they have anemia. Doctors suspect thalassemia if a child has anemia and is a member of an ethnic group that is at risk for thalassemia.

To distinguish anemia caused by iron deficiency from anemia caused by thalassemia, tests of the amount of iron in the blood may be done. Iron-deficiency anemia occurs because the body doesn’t have enough iron for making hemoglobin. The anemia in thalassemia occurs not because of a lack of iron, but because of a problem with either the alpha globin chain or the beta globin chain of hemoglobin. Iron supplements do nothing to improve the anemia of thalassemia, because missing iron is not the problem.

Family genetic studies are also helpful in diagnosing thalassemia. This involves taking a family history and doing blood tests on family members.

Prenatal testing can determine if an unborn baby has thalassemia and how severe it is likely to be.

----------

From what I can tell, there is not really a simple blood test to tell. As it says here, they look at the results of several things in the CBC. There is a way to do genetic and prenatal testing, but I think that may be more difficult/expensive. They should be able to tell from the CBC if they know what they are looking for.

I know that the odds of this being what is going on with you are out of this world, but wouldn't it be amazing if it were? I don't have to do a single thing for mine.

It takes me almost 2 weeks to get my results when I have my yearly CBC done. Please let us know your results when you get them. Good luck.

[LooseShoes]

Re: Biogeek, Please Help!

Thanks, Mitzi! It'd be great if it was something I really didn't have to be treated for. I did OK today because I didn't take the extra iron today. Dr said I could do every other day.

I'll definitely ask the dr about it. I can't believe that anything (taking iron) that makes me feel this bad can be good for me.

I did start the liquid B-12 supplement yesterday. Figured it can't hurt, and if it helps, then great.

[biogeek]

Re: Biogeek, Please Help!

Dear Caryl,

Sorry for the late reply...I took a short vacation & just got home late last night.

Kiss and Mitzi have given you some excellent information and I hope you find out which type of anemia you are suffering from.

Vitamin B12 shots are normally given to those that suffer from pernicious anemia, which is a chronic type of anemia where those that have it lack an intrinsic factor (IF) that normally is secreted with other gastic fluids. The adult onset usually occurs between ages 40-70, with the average around 60 years of age. In the US, it is also more common to find this type of anemia with those of English, Irish, Welch, and Scandinavina descent, but all races can get it. There are also a myriad of symptoms that occur as well. However, the best thing is to have a physician do the testing.

B12 shots can also help other forms of anemia as well, and there are hundreds of types of anemia, not just a handful. One way of classifying anemia is to determine whether the anemia is nutritional or non-nutritional. Most folks are familiar with the nutritional type, where you need more iron, Bs, C, etc. It can also be cause by malfunctioning enzymes, either too little or non-existant, that breakdown the vitamins into their more active forms.

Non-nutritional types of anemia usually have something to do with RBCs: lack of RBC precursors for their development, RBCs dying off too quickly (premature), decreased erythrocyte formation, etc.

According to the Iron Disorders Institute, http://www.irondisorders.org/ , anemia has a wide variety of definitions. The following are just a few which will explain why it is so difficult to classify over 400 anemias into one convenient description.

Anemia is:

• a condition in which the number of RBCs is below normal
• a reduction in total circulating RBC mass, diagnosed by a decrease in hemoglobin concentration
• a hemoglobin level below 12 g/dl
• any condition resulting from a significant decrease in the total body erythrocyte mass
• a decrease in the circulating RBC mass and a corresponding decrease in the oxygen-carrying capacity of the blood
• a decreased ability of RBCs to provide adequate oxygen supplies to body tissues
• a reduction in the hemoglobin concentration to below 13.5 g/dl in an adult male and to below 11.5 g/dl in an adult female
• any condition characterized by an abnormal decrease in the body’s total RBC mass
• a condition in which either RBCs or the amount of hemoglobin (oxygen-carrying protein) in the RBC is low
• a condition in which a person has inadequate amounts of iron to meet body demands
• a decrease in the amount of RBCs in the blood caused by having too little iron
• having fewer than the normal number of RBCs or less hemoglobin than normal in the blood
• decreases in numbers of RBCs or hemoglobin content caused by blood loss, deficient erythropoiesis, excessive hemolysis, or a combination of these changes
• a blood disorder that results from a shortage of hemoglobin in the RBCs, the disk-shaped cells that carry oxygen to all parts of the body
• an abnormal reduction in RBCs
• a condition when the amount of RBCs or hemoglobin becomes low, causing the tissues of the body to be deprived of oxygen-rich blood
• a reduction in the number of RBCs in the body
• a condition in which the blood is low on health RBCs

When you get your bloodwork and they are trying to determine which type of anemia you have, one thing they must do is look at how your RBCs are compared to normal.

If there are changes in size, shape, or color, this is how they are described:

• Cell size: (Terms that refer to cellular size end with "cytic".)
• normocytes (normal) microcytes (smaller than normal) macrocytes (larger than normal) anisocytes (various sizes)
• Cell shape: poikilocytes (irregularly-shaped cells) spherocytes (globular cells) drepanocytes (sickle cells)
• Cell color: (generally refers to the staining characteristics which reflects the hemoglobin concentration. Terms that describe hemoglobin content end with "chromic".) normochromic (sufficient or normal amounts of hemoglobin) hyperchromic (containing an unusually high concentration of hemoglobin in its cytoplasm) hypochromic (containing an abnormally low concentration of hemoglobin)

The above changes can produce the following categories of anemias:

• Macrocytic-normochromic anemias (pernicious and folate-deficiency)
• Microcytic-hypochromic anemias (iron-deficiency, sideroblastic, thalassemia)
• Normocytic-normochromic anemias (aplastic, posthemorrhagic, hemolytic, chronic disease, sickle cell)

There's so much information on anemia, and this is just the icing. If you want more information, I would be happy to provide it, direct you to reputable websites, or give you journal article citations. I, however, do not wish to confuse you or make you frightened.

I will be home the next couple of days to recover from my vacation , but I will be checking in at least once a day until I get to work on Thursday when I will be on more frequently.

I'll keep you in my thoughts!

[LooseShoes]

Re: Biogeek, Please Help!

Thanks so much, Bio!

I noticed on the link you provided that they had a magazine about hypothyroidism and anemia. I do have low thyroid, again since I was a child. I've been on medication since I was about 5 yo. I didn't really know there was a connection. Do you know anything about it?

You are an absolute fount of wisdom and knowledge! Thanks again.

[biogeek]

Re: Biogeek, Please Help!

Caryl,

I'm glad to be of some help!

There's been a lot of clinical research that have been done on anemia, hypothyroidism, hyperthryroidism, but not necessarily combinations thereof. It is common for those that have thryoid disfunction to develop anemia, but it doesn't necessarily mean that one causes the other and vice versa, nor do you have to have both. When I get back to the office, I can do a more detailed search on the university's system for clinical articles.

What I do know is that when both anemia and thyroid impairment are present, the anemia that develops tend to be nutritional anemia with either really low iron and/or possibly, extremely low copper levels depending on the type of anemia that develops. Hyperthroidism tends to have the ultralow copper compared to hypothroidism.

It also depends on the type of hypothroidism one has as well, primary versus secondary. The symptoms for both are the same, it's the underlying disfunction that is different. With primary hypothyroidism, the low thryoid production occurs at the thyroid gland itself for various reasons: innate disfunction, antibodies attacking the thryoid, or some other injury.

With secondary hypothyroidism, it is either a lack of TRH (throtropin-releasing hormone) from the hypothalamus or low TSH (thyroid stimulating hormone) from the pituitary gland, which in turns leads to a lack of stimulation of the thyroid gland.

I don't know if you're seeing a primary care physician or an endocrinologist, but if I were you, I would become as knowledgable as possible about both anemia as well as hypothyroidism so that you can really ask good questions to your physicians and don't leave their office until you are completely satisfied with the answers they give you. You need to be your own advocate so that you get the best healthcare that you deserve.