Hi
It has been too long since I worked with clinincal biochemistry..my
harddisk is malfunctioning and when it works data is outdated..

My wife had a row of samples taken a couple of months ago - her Hb close to
5 mmol/l, B12 below normal as well - and of course a blood picture matching
these findings.
She has now had injections with vit-B, and iron supplementation - - and all
figures have returned to normal - only her transferrin and ferritin is still
pretty much below normal.
We suspect she is loosing blood from one of her kidneys: periods are week or
very week, no blod loss in her faeces, but in general urine stix show one
plus for blood. She has been referred to hospital now to have it examined.
Though - I suspect with only normal findings - she underwent thorugh
examination some years ago due to the same conditions with no result.

But, do you have any idea as to the low ferritin/transferrin - none we have
asked seem to be able to explain that? Shouldn't at least her transferrin be
high on low iron levels.
I suppose I ought to tell that she doesn't drink, is a non-smoker - lives
quite healthy and has no known liver disease. -

Regards, Leo

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First, is a Hb (Hgb?) measure in units =5 mmol/l a European thing (I note
.dk and assume dk = Denmark).
Well, I can't answer your question directly (but as I see that no one else
has), but if there is anemia, I REALLY don't like taking iron _until_!!! the
problem is properly diagnosis.  The Hgb (BTW, the MCV is important here) may
impoved by supplementing what is being lost but fear covering up a chronic
problem that may get worse (those requiring more of the supplements).  Old
vietnamese saying is one who has self for danh tu ( "ba'c si") has fool for
ba'ci si!

-----------------------------------------------------
First Manassa July 22nd Mega Event  Any techs what sometime vastly different
for vacation (taint gona be easy!)?  Our British contigent is coming over
the pond.

"Leo" <fupkonto@hotmail.com> wrote in message
news:43e9dc66$0$2503$edfadb0f@dread14.news.tele.dk..
> Hi
> It has been too long since I worked with clinincal biochemistry..my
> harddisk is malfunctioning and when it works data is outdated..
>
> My wife had a row of samples taken a couple of months ago - her Hb close
> to
> 5 mmol/l, B12 below normal as well - and of course a blood picture
> matching
> these findings.
> She has now had injections with vit-B, and iron supplementation - - and
> all
> figures have returned to normal - only her transferrin and ferritin is
> still
> pretty much below normal.
> We suspect she is loosing blood from one of her kidneys: periods are week
> or
> very week, no blod loss in her faeces, but in general urine stix show one
> plus for blood. She has been referred to hospital now to have it examined.
> Though - I suspect with only normal findings - she underwent thorugh
> examination some years ago due to the same conditions with no result.
>
> But, do you have any idea as to the low ferritin/transferrin - none we
> have
> asked seem to be able to explain that? Shouldn't at least her transferrin
> be
> high on low iron levels.
> I suppose I ought to tell that she doesn't drink, is a non-smoker - lives
> quite healthy and has no known liver disease. -
>
> Regards, Leo
>
>

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Since you wife's Hgb and B12 are both low it would apprear that she has a
Vitamin B12 deficiency.  This can be checked by looking at two additional
parameters that should have been checked at the time.  Her MCV will be
greater than 100 if she has frank B12 deficiency.  You might also have the
results of her WBC differential, if so check for the Red Cell Morphology
which might indicate macrocytic cells and White blood cell morphology which
might indicate hypersegmented neutrophils (polys).  Supplementing with iron
would not be appropriate if this is a B12 deficiency and might be an
indication of her physician trying to cover all bases prior to determining
the exact cause of the anemia.

I do not know how old your wife is or her medical history but, does she have
some sort of stomach problem?  B12 cannot be absorbed by the body without
intrinsic which is supplied by cells in the stomach lining.  Any way because
of the cell cycle of the Red Blood Cell it may yake as much as 2 to 3 months
before a significant change will be seen in her anemia.  This is because the
lifecycle of a red cell in the peripheral circulation is about 120 days.
Since the mid point in the cycle is 60 days look to that time period for
half of her red cells to be replaced before expecting a significant change.

Now, as for the Ferritin and Transferrin.  Ferritin is the storage form of
Iron in the body and shows long term iron load.  WIth a severly depleted
iron storage it may take some time to see the ferritin rise because of other
iron committments made by the body for normal metabolism (i.e. red cell
production, bacteriocidal uses, etc.).  Transferrin is a transport form of
iron and is dependent on the body protein stores as well as available iron.
One function of proteins in the body is the transport of a wide variety of
intermediary metabolic products and elements to thier active sites or
endocrine glands for incorporation into the metabolic cycle.

A number of disease processes can interfere with proper transport and
stroage of iron in the body, while this list is not all encompassing nor a
guide to making a diagnosis, you should make sure that you investigate,
diseases of the stomach and small intestine, spleen, and liver.  This may be
a benign process that can be explained as simply as inability to absorb B12
and iron from the gastrointestinal tract.  Or, it may be a symptom of a
deeper problem necessitating consulation with a qualified hematologist or
oncologist in your area.

I hope this has help a little.  Let me know it I can help further.


Arcie Mizelle

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