Tuesday, March 26, 2013

Live from the Infusion Center: Anemic Again

My blood draw at the cancer center for my IVIG infusion showed that I am mildly anemic again. Hgb was only 13.2 which is the lowest it has been since last August. 

This almost certainly not a big deal unless my counts continue to fall. 13.2 is a value many with CLL aspire to reach.

The white count, neutrophils and lymphocytes were all fine and platelets were 381,000.

However, I am clearly iron deficient based on lack of iron stores seen on my bone marrow biopsy, a low iron saturation of 14% and a borderline ferritin of 22.

My marrow was making adequate red cells so that is not the issue, and there is nothing clinically or in my lab to suggest an auto-immune problem (AIHA), so the nutritional deficit is the likely culprit. B12 is fine, daily I eat a ton of leafy greens with high levels of foods with folate, so that leaves the finger pointing at iron. 

Doctors Kipps and Forman agreed that there was no need for iron replacement a few weeks ago as I was not anemic when my blood was last checked a month ago, but the sharp eyed Dr. Kipps did notice that my MCV, a measure of the red blood cell size, was drifting down. My erythrocytes tend to be too big and funny looking due my splenectomy, but lately they have been more normal size, consistent  with a mixed picture of multiple influences on their size and shape, as low iron stores will shrink cell size.

Vegan like me are at higher risk for iron deficient anemia as the iron found in veggies is not as easily absorbed as the iron in blood. There is some controversy on this, but it makes sense. Heme iron is found in animal proteins, while non-heme iron is found in plant-based foods and has a different molecular structure than heme iron.

All the green tea I drink doesn't help either, as it interferes with absorption.

I am not too worried about a GI bleed as my last colonoscopy was only 3 1/2 years ago.

So why not take iron?

First iron overload is a much bigger problem and harder to remedy down the line in blood cancers.

Second, there is some controversial data (in dialysis patients) suggesting that iron supplementation may be associated with increased infection risks and low iron may be protective. Again, there is conflicting data.

Finally iron is constipating and can cause other GI issues.

I think I will just start taking more blackstrap molasses. And check for my stool for blood. And watch the trend. 

All in all, not a bad picture. Much better than the numbers that too many friends need to contend with.

Still one time, I would love to have a blood count with no numbers in the red. I haven't seen that in 8 years. Not once since I was diagnosed.

BP is 107/68 and I need a nap.

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2 Comments:

Anonymous Anonymous said...

Hi Brian

You mention that taking iron supplements might cause problems down the line. What exactly do you mean by that? My hgb is currently at 12 so I have started taking spatone again.

Bill

March 27, 2013 at 5:47 PM  
Blogger Brian Koffman said...

Hi Bill,

Iron over load is a difficult issue should one become transfusion dependent. It can damage the liver and the heart, and treatment is fraught with risks. Overload can happen when the marrow is impacted with CLL, or if there in an rapid and severe drop from AIHA (though results are very temporary and it is best avoided), or if one develops MDS.

I would not take an iron supplement unless you are certain that is the cause of your anemia. Most anemia in CLL is NOT from low iron, but from bone marrow failure and iron will not help. Measuring iron, iron binding capacity, and ferritin can help sort this out.

Stay strong

Brian

March 29, 2013 at 4:31 PM  

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