Anemia questions

[Maya142]

M had blood work (iron studies) done to determine if she was anemic. Before she had it done, her hematologist said he thought this was just anemia of chronic disease. Her hemoglobin (which is usually 11.0 or above) is 9.4, and he said he was 99% sure it was anemia of chronic disease and nothing else. But I got her results today and everything I read online says it isn't that. Any ideas?

The iron studies came back today and I'm confused.
Hemoglobin is 9.4 (again) (low)
Total iron is 149 (range is 40-175)
TIBC is 293 (range is 250-450)
% Saturation is 49 (range 15-50)
Ferritin is 183 (range is 10-154) (High)

Vitamin B-12 is 585 (range is 200-1100)
Folate is normal (no number)
And Vitamin D is 46 (range is 30-100)

 

[Catherine]

It doesn't look how I would expect anemia of chronic disease to appear.

Can I tell where your ancestors come from?

 

[Maya142]

My girls are half Indian (like from India, not Native American!) and half Caucasian (husband's ancestors are from Ireland).

 

[Catherine]

Greece, Italian?

 

[Maya142]

Nope just Ireland, and I think he has some German blood but not sure. Why, what does that have to do with anything?

 

[Catherine]

In our travels for a dx for the cause of DD anemia there was a mention of thalassemia.

Thalassemia Beta - occurs mainly in people of Greece origin (northern Europe).
Thalassemia Alpha - occurs mainly in people from Asian origin.

Although we are not of any to the main risk populations eg Ireland/Scotland on all side, DD was tested for both forms.

The reason they gave testing for this was that her ferritin increase while supplementing with iron but her haemoglobin level fell.

 

[Maya142]

We actually have tested for thalessemia trait (it runs in my family) but I don't have it and neither do my girls (my brother does though).

M is not on iron supplements, just a multivitamin. I just don't understand why her hemoglobin is falling while everything else is ok? Her hematologist wasn't concerned about ferritin, said it was high from inflammation and it's an acute phase reactant.

 

[Catherine]

Is ferritin is acting as acute phase reactant and this anemia of chronic disease. Then the treatment is to get the underlining condition under control.

So her Crohn's would be active? So what is the plan to get the Crohn's under control?

 

[Maya142]

Just added Imuran in June. I guess it's just going to take a while

Thanks!

 

[Catherine]

Maybe a course of pred? Would give the Imuran time to work.

 

[my little penguin]

^^^ yeah that
Since Imuran can take 3-6 months ...

 

[Maya142]

We did discuss Entocort but given her joints are no better, I'm guessing prednisone would a better option.

The difficulty is that her bone density has significantly decreased since 2011 (still within range but much worse than 2011) so both her rheumatologist and GI are trying to avoid steroids.

We will DEFINITELY talk about EEN at her next GI appointment in a few weeks, but I really doubt she'll agree to it.