Suggest Treatment For High Serum Iron Levels

Posted on Mon, 6 Jun 2016

Question: My blood iron index is over a thousand and my hemoglobin is low enough to discourage bleeding. Would bleeding out a pint every month and adding a pint in transfusion be a viable way to reduce my blood iron ?

Answered by Dr. Indranil Ghosh (26 minutes later)

Brief Answer:
no that's not a solution

Detailed Answer:
Hi
Thanks for your query.

Do you mean serum ferritin level over a thousand, when you say blood iron index? I also need your serum iron, iron binding capacity and serum ferritin exact values as well as hemoglobin level, to answer your query properly.

However, draining blood and replacing with blood won't reduce iron overload, as iron will replace iron. Iron chelators may be required.

Please let me know the information I requested and I can guide you better.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (33 minutes later)

Yes, I'd forgotten the exact term but thought that the number would identify that is is the serum feritin level. My thinking on the bleed/replace is dilution. If, for instance, a pint of 1000 blood is removed, that would leave about 9 pints of blood at 1000. Add one pint of blood at about a 100 level and we should get :
9 pints @ 1000 plus 1 pint @ 100 divided by 10 which would uqual a level of 910
Do this once a month for about 15 months and the number would be under 250..
Of course, that assumes all other things would stay equal.
If this doesn't seem plausable, what would you recommend as a way of gaining control of this apparently dangerous blood iron level. Just spoke to my nurse at the VAMC and got the numbers you requested.

latest ferrin level = 1148.9
iron binding = 266
hemoglobin = 11

Am doing a liver function and ferritin level blood test again on 4/7 and have an appt. with Hemotology at the VA on 4/12.
I requested the recheck on ferritin level because the 1148 level seems to have come out of nowhere because the last check in January was 659 and had fluctuated between 477 and 659 for the past 5 or more years. Since I've had no other life stlye changes (diet etc), the spike may be due to a contamination or ?

Answered by Dr. Indranil Ghosh (6 hours later)

Brief Answer:
no your method won't work

Detailed Answer:
Ferritin denotes tissue iron stores and not in blood. So replacing blood with blood will not change anything.

Ferritin is also an acute phase reactant and gets elevated in various conditions, without iron overload. I think this phenomenon is at play here. So don't jump on depleting iron as yet. Also please send me the serum iron level, which is missing.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (18 hours later)

Thanks Doc, for your valuable advice to this point. It seems that my Primary Care Doctor at the VA is turning our to be unnecessarily alarmist because, when he talked to me I got the impression that I was FACING A VERY SERIOUS ISSUE AND HE TOLD ME HE WAS PUSHING Hematology to bleed me even though they previously said they thought my hemoglobin was too low.
The last number you requested, blood serum, is listed on the lab report as iron. That number is 252. I understand that the normal range is 45 to 182..
Could you please put everything in perspective for me. Especially if you consider a bleeding necessary and is a number like 252 a reason for concern.
Thanks..

Answered by Dr. Indranil Ghosh (6 hours later)

Brief Answer:
bleeding not necessary and not feasible too

Detailed Answer:
Serum iron is indeed high. But bleeding will worsen the hemoglobin which is not acceptable in your case. Most likely there is some bone marrow problem which is hampering with iron handling in your body.

If the serum iron and ferritin are increasing, then some meds to reduce body iron required. Otherwise just followup.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar