Iron Deficiency Anemia or Anemia of Chronic Disease?

[Remy]

Did you know that there is a condition called Anemia of Chronic Disease (ACD)? I didn't until today and it sure fits my bloodwork better than Iron Deficiency Anemia (IDA) ever did.

The Iron Disorders Institute has lots of good things to say including this definiton of ACD:

Anemia of chronic disease (ACD) is also referred to as anemia of inflammatory response. Although ACD can accompany life-threatening illness, anemia of inflammatory response is in fact a protective and natural mechanism that the human body uses to limit the amount of iron available when potentially harmful things get into our body.

Both conditions typically feature low hemoglobin but ACD often will have normal, not low, ferritin levels as the iron is stored away in the liver to keep it from feeding pathogens.

I run into some trouble here though because a "normal" ferritin level can be as low as 11 and most doctors I have seen would call that low, even if technically normal So where exactly is the cut off for ferritin with ACD? Does the literature say? Are these doctors really only diagnosing IDA with a low hemoglobin and ferritin less than 11? Because that's nuts and I daresay a lot of those people actually have ACD and in that case giving iron will produce less than desirable results and may even cause harm.

Ferritin can also be increased by inflammation...the very same thing that causes ACD. So personally I think ferritin is a crap way to differentiate between IDA and ACD for the majority of patients, especially when the consequences of giving supplemental iron can be fatal to a person with ACD.

To further confound the picture, in mast cell disorders, the hemoglobin is often inflated well above where one would expect to see it in people with an inflammatory disease. A typical hemoglobin level for someone with chronic inflammation would be somewhere around 9-10. But if you have mast cell issues, you may have a perfectly "normal" hemoglobin level in the face of ACD due to the release of a cytokine called Activin A which promotes RBC growth.

TIBC is another marker typically found on an iron panel which may help sort things out. Typically in IDA, TIBC will be above 400. TIBC is iron binding protein. And when you need more iron, its level will rise. When your body can't safely bind up any more iron (as in ACD), it will be low. My TIBC is almost always at the bottom of the range despite low serum iron and "normal" (low) ferritin.

I wonder how many of us have fatigue of a symptom of ACD that is masked by even "minor" levels of mast cell activation? Mast cell issues commonly also cause increases in NE...could hyperadrenergic POTS really be just another manifestation of these poorly understood mast cell syndromes?

Things to ponder.

 

[Cort]

Did you know that there is a condition called Anemia of Chronic Disease (ACD)? I didn't until today and it sure fits my bloodwork better than Iron Deficiency Anemia (IDA) ever did.

The Iron Disorders Institute has lots of good things to say including this definiton of ACD:



Both conditions typically feature low hemoglobin but ACD often will have normal, not low, ferritin levels as the iron is stored away in the liver to keep it from feeding pathogens.

I run into some trouble here though because a "normal" ferritin level can be as low as 11 and most doctors I have seen would call that low, even if technically normal So where exactly is the cut off for ferritin with ACD? Does the literature say? Are these doctors really only diagnosing IDA with a low hemoglobin and ferritin less than 11? Because that's nuts and I daresay a lot of those people actually have ACD and in that case giving iron will produce less than desirable results and may even cause harm.

Ferritin can also be increased by inflammation...the very same thing that causes ACD. So personally I think ferritin is a crap way to differentiate between IDA and ACD for the majority of patients, especially when the consequences of giving supplemental iron can be fatal to a person with ACD.

To further confound the picture, in mast cell disorders, the hemoglobin is often inflated well above where one would expect to see it in people with an inflammatory disease. A typical hemoglobin level for someone with chronic inflammation would be somewhere around 9-10. But if you have mast cell issues, you may have a perfectly "normal" hemoglobin level in the face of ACD due to the release of a cytokine called Activin A which promotes RBC growth.

TIBC is another marker typically found on an iron panel which may help sort things out. Typically in IDA, TIBC will be above 400. TIBC is iron binding protein. And when you need more iron, its level will rise. When your body can't safely bind up any more iron (as in ACD), it will be low. My TIBC is almost always at the bottom of the range despite low serum iron and "normal" (low) ferritin.

I wonder how many of us have fatigue of a symptom of ACD that is masked by even "minor" levels of mast cell activation? Mast cell issues commonly also cause increases in NE...could hyperadrenergic POTS really be just another manifestation of these poorly understood mast cell syndromes?

Things to ponder.

I don't know anything about iron but I'm going to present a blog soon on a young man with POTS. This what his mother wrote.

For us, one HUGE ingredient for success is sucrose iron infusions. Many POTS patients have low ferritin iron (Jack was 18nl/ml and some patients as low as 2nl/ml). I found a reference to a cancer Doctor in Dallas doing Feraheme infusions for POTS patients with great results (Feraheme has significant side effects and I would recommend the more laborious and shorter acting Venofer). The Venofer infusions made a significant difference with Jack’s energy and exercise intolerance which then had knock-on effects – getting us to our estimated 80% of capacity to include ¾ school days and consistent light exercise prior to our attendance at the Mayo’s PPRC 3.5 week intensive.

Dr. John Whiting has been talking about iron for years as well. I hope to get him to do a blog about it at some point.

 

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Great thread. I definitely have something wrong in this area, just hoping it fixes as I improve more.

Fluctuating anaemia type thing.

 

[Remy]

Who is 'deleted member'?

So weird!

 

[catalonia13]

I had IDA for some 18 years, until 5 years ago was otherwise fit and well then auto-immune issues started kicking in, had Thyroid Eye Disease, then became Hypothyroid, diagnosed with Celiac in Feb 2016 (asymptomatic) and am IgA deficient.

just over a year ago my ferritin went above range and I was told to stop taking iron meds, my iron has consistently dropped at every 3 month test since then, last test was dec 2016 8.2 (range 11.5 - 30) 2 weeks ago I started to really struggle physically, fatigue (normal for me but worse than ever, head hurts all the time, taking deep breaths, fat tongue on waking up) rang GP, she couldn't do anything more until she'd heard back from gastro, (she wrote on April 5th because in January my Immunologist said I need iron but gastro said not to take them!) I did ask again for a referral to Haemo but this was refused.

Today I got a copy of the letter from Gastro to my GP , she has requested iron studies, ferritin, TTG and CRP (CRP has been in range at every test, it's my ESR that has been raised for the last 2 years) but also stated

"her ferritin has always been elevated" -
Nope!

"she was not even anaemic when we last checked" -
so 8.2 is not anemic?!

"still withhold the iron tables and only treat when we have clear evidence of iron deficiency"
I DON'T have iron deficiency now, I have too much in stores (ferritin) and not enough circulating (serum iron) , BIG difference, and apparently taking iron could be dangerous.