5!

[DianaCox]

He SAYS...most of stomach gone means most of intrinsic factor gone and this will just be part of my life from now on. I was always "borderline anemic," losing stomach tissue made it worse.

Not as bad as an RnY would have made it...but it is worse than in my earlier life...when they just didn't let me donate blood.

AFAIK, I'm not bleeding anywhere...I've had a half dozen colonoscopies that confirm that and there wasn't even trace blood in the last UA, unusual for me. So...I just don't absorb enough because I don't have, according to him, enough stomach acid, due to insufficient intrinsic factor. Although my reflux-y evenings might be enough to counter that position.

This makes no sense to me. Intrinsic factor is needed to take up B12, not iron. http://en.wikipedia.org/wiki/Intrinsic_factor

If your doctor said this, I worry whether he knows shit about what he's talking about.

Here is something particularly interesting: http://en.wikipedia.org/wiki/Iron_deficiency

Bioavailability and bacterial infection[edit]
Iron is needed for bacterial growth making its bioavailability an important factor in controlling infection.[20] Blood plasma as a result carries iron tightly bound to transferrin, which is taken up by cells by endocytosing transferring, thus preventing its access to bacteria.[21] Between 15 and 20 percent of the protein content inhuman milk consists of lactoferrin[22] that binds iron. As a comparison, in cow's milk, this is only 2 percent. As a result, breast fed babies have fewer infections.[21]Lactoferrin is also concentrated in tears, saliva and at wounds to bind iron to limit bacterial growth. Egg white contains 12% conalbumin to withhold it from bacteria that get through the egg shell (for this reason prior to antibiotics, egg white was used to treat infections).[23]

To reduce bacterial growth, plasma concentrations of iron are lowered in a variety of systemic inflammatory states due to increased production of hepcidin which is mainly released by the liver in response to increased production of pro-inflammatory cytokines such as Interleukin-6. This functional iron deficiency will resolve once the source of inflammation is rectified, however if not resolved it can progress to Anaemia of Chronic Inflammation. The underlying inflammation can be caused by fever,[24]Inflammatory Bowel Disease, infections, Chronic Heart Failure (CHF), carcinomas and following surgery.

Reflecting this link between iron bioavailability and bacterial growth, the taking of oral iron supplements causes a relative over abundance of iron that can alter the types of bacteria that are present within the gut. There have been concerns regarding parenteral iron being administered whilst bacteremia is present, although this has not been borne out in clinical practice. A moderate iron deficiency, in contrast, can provide protection against acute infection, especially against organisms that reside within hepatocytes and macrophages such as Malaria and TB. This is mainly beneficial in regions with a high prevalence of these diseases and where standard treatment is unavailable.

 

[kirstabelle]

@Sheanie & @Spiky Bugger - I have no way to change hemo. He is the boss guy in my part of the country (Scotland) and so I have nowhere left to turn.
He says there is no medical proof that iron deficiency is symptomatic before anaemia hits. He also claimed it would be impossible to calculate how to give a dose if my Hgb is not low.
I know that is complete bullshit but my words fail me when I speak to him on the phone cos I am so damn tired and fed up!
If it was Vit D/Calcium he was bullshitting about I would feel confident calling him out on it.
Its like saying someone will not be given insulin until they get into a diabetic coma.
If any of you have any papers/info refuting his claims I would be most grateful. Through the joys of google I have dug out his email address and I intend to contact him (BIG NO NO in NHS/UK)
I have tiredness, flaking nails, low concentrations level, thinning hair, ghostly complexion, RLS......

 

[kirstabelle]

What's the range your results should fall in? And you need a new doctor. This one could make you very sick.

Normal is 20-200

 

[Spiky Bugger]

This makes no sense to me. Intrinsic factor is needed to take up B12, not iron. http://en.wikipedia.org/wiki/Intrinsic_factor

If your doctor said this, I worry whether he knows shit about what he's talking about.

Here is something particularly interesting: http://en.wikipedia.org/wiki/Iron_deficiency

Bioavailability and bacterial infection[edit]
Iron is needed for bacterial growth making its bioavailability an important factor in controlling infection.[20] Blood plasma as a result carries iron tightly bound to transferrin, which is taken up by cells by endocytosing transferring, thus preventing its access to bacteria.[21] Between 15 and 20 percent of the protein content inhuman milk consists of lactoferrin[22] that binds iron. As a comparison, in cow's milk, this is only 2 percent. As a result, breast fed babies have fewer infections.[21]Lactoferrin is also concentrated in tears, saliva and at wounds to bind iron to limit bacterial growth. Egg white contains 12% conalbumin to withhold it from bacteria that get through the egg shell (for this reason prior to antibiotics, egg white was used to treat infections).[23]

To reduce bacterial growth, plasma concentrations of iron are lowered in a variety of systemic inflammatory states due to increased production of hepcidin which is mainly released by the liver in response to increased production of pro-inflammatory cytokines such as Interleukin-6. This functional iron deficiency will resolve once the source of inflammation is rectified, however if not resolved it can progress to Anaemia of Chronic Inflammation. The underlying inflammation can be caused by fever,[24]Inflammatory Bowel Disease, infections, Chronic Heart Failure (CHF), carcinomas and following surgery.

Reflecting this link between iron bioavailability and bacterial growth, the taking of oral iron supplements causes a relative over abundance of iron that can alter the types of bacteria that are present within the gut. There have been concerns regarding parenteral iron being administered whilst bacteremia is present, although this has not been borne out in clinical practice. A moderate iron deficiency, in contrast, can provide protection against acute infection, especially against organisms that reside within hepatocytes and macrophages such as Malaria and TB. This is mainly beneficial in regions with a high prevalence of these diseases and where standard treatment is unavailable.

Well, then, he probably DIDN't say that...and I'm probably confused because of the anemia and we did discuss other things related to malabsorption...like B12 deficiency...and so...
everyone should ignore the WHY I have this part of my post.

But...my Ferritin is 5, I'm not bleeding anywhere we can find, and I've been getting iron infusions about every six to nine months for several years now.

I think.

 

[DianaCox]

I certainly have not felt symptomatic when my ferritin was extremely low (12), nor, sadly, did I feel better (I was hoping for improvement over "OK") when I got it up into the 200 range. But my hematologist - who deals with bariatric patients - understands the problems with ferritin levels and bariatric guts and why infusions should be given when hemoglobin is OK and ferritin is in the 20s. As your hematologist (HAHAHAHA!) to call Dr. Brian Henderson in San Mateo CA: (650) 348-0893

 

[Spiky Bugger]

I certainly have not felt symptomatic when my ferritin was extremely low (12), nor, sadly, did I feel better (I was hoping for improvement over "OK") when I got it up into the 200 range. But my hematologist - who deals with bariatric patients - understands the problems with ferritin levels and bariatric guts and why infusions should be given when hemoglobin is OK and ferritin is in the 20s. As your hematologist (HAHAHAHA!) to call Dr. Brian Henderson in San Mateo CA: (650) 348-0893

All of my iron is out of range...
Iron 34 (40-160)
UIBC 514 (110-370)
TIBC 548 (250-450)
Transferrin Sat 6% (15-50%)
Ferritin 5 (20-288)

Hemoglobin is slipping out the bottom. 12.1 (11.7-15.5)

 

[Elizabeth N.]

Spiky, have they tested to see if you have hemolysis going on? I don't remember the name of the blood tests, but it's to see if you're killing your own red blood cells. I'm mildly positive for that, so the doc is of the opinion that's why I'm losing iron--slowly, but still happening.

 

[Spiky Bugger]

Spiky, have they tested to see if you have hemolysis going on? I don't remember the name of the blood tests, but it's to see if you're killing your own red blood cells. I'm mildly positive for that, so the doc is of the opinion that's why I'm losing iron--slowly, but still happening.

I'm having a something-pharesis test to confirm or rule out Thalessemia. I have a lifelong hx of "borderline" anemia and my Sicilian (a hotbed of activity for this genetic quirk) grandparents had two babies die in infancy, only explanation "bad blood," and none of my father's siblings were blood donors..."bad blood," and the Red Cross blood drive people used to give me cookies and orange juice and tell me to go away.

If it isn't Thalessemia, then there is probably going to be no explanation. Unless I'm bleeding into a bottomless internal cavity and it's all just staying there. No blood in stool or urine.