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.

Scatological studies

On my bone marrow biopsy, they found no iron stores. That is very rare in men. Could mean internal blood loss.

But wait you say, you're vegan. Couldn't that explain it? Well, vegan may have no good source of B12, but all iron comes from the ground and is found in many leafy greens (the cows you meat eaters boast of for their high iron content got theirs from eating greens). Veganism does not explain away my low iron.

But you said you are not anemic. That's reassuring, isn't it? Sorry, but that is the last place an iron deficiency shows up. An analogy: The car may still have a full tank of gas, but the petrol station is bone dry.

You might even know that ferritin, the terribly important iron binding protein, is a very sensitive marker of low iron stores and yours is normal so no worries, mate. But remember that CLL is a looking glass world where appearance can deceive, and all things protein and protean are not reliable. Ferritin levels fluctuate with inflammation and are less trustworthy in CLL.

The real contradiction is that the iron studies in my blood, the total iron, the percent that is bound, and the total iron binding capacity are all within normal limits. That makes no sense with no iron in the marrow.

Add it up and what do you get? A contradiction. Now that is familiar CLL territory.

Likely my iron is fine in both my blood and in my marrow, but the test was messed up. It was a poor specimen, and the leaching technique to get rid of the calcium for the iron stain, if not done perfectly, can botch the results.

So how is this scatological? Seems more hematological?

Because the contradiction must be resolved, I need a colonoscopy and EGD tomorrow to make sure I am not bleeding from some occult GI source. Time for a look-see. My last scope was when I turned 50, so it's time anyway.

For those of you who have experienced the prep, you know I am not leaving home tonight. I am not even venturing far from the toilet.

Now you get the scatology.