Why might ferritin still be high - despite heavy bloodloss?
January 20, 2023 8:28 PM
I have heavy periods and require regular iron transfusions approximately every 18 months. For the last few months, my periods are heavier than ever (thanks peri-menopause) but my ferritin has remained high at 200 ug/L. What might be causing this?
Preface
I'm seeing my haematologist on Monday, but find I do better with some targeted questions or some possibilities to put to her. Hence this question!
Background
For the past three years, I've kept an extremely close eye on my iron so I can catch when levels are low enough to need a transfusion ASAP. I have blood tests after every menstrual cycle. In the past, I’d see ferritin decline steadily after every bleed until at around 100 ug/L I would be in full-blown low iron territory with a host of symptoms and need another transfusion.
I have non-alcoholic fatty liver which makes ferritin levels appear high on blood tests, despite symptoms of low iron. But I would expect to see symptoms at 100, not 200-plus.
I am now literally flooding for a couple of days at a time, changing a tampon AND period underwear hourly, sometimes still bleeding through my clothes. But ferritin remains bizarrely high at 200 over my last three cycles.
Directly after my last transfusion, eighteen months ago, ferritin was 347 ug/L, transferrin saturation 27%, transferrin 2.67 g/L and iron 18 umol/L.
Lab reference ranges are: Iron 8-30 umol/L, Ferritin 30-250 ug/L, transferrin 2.00-4.00g/L and transferrin saturation 10-35%.
My last three tests show ferritin between 200-218. Transferrin is also steady at between 2.59-3.0 g/L. Iron and transferrin saturation have dropped though - on the last test iron was down to 10 umol/L, and transferrin saturation to 14%.
Other possible issues: I had biliary dyskinesia about 18 months ago and a host of issues with my pancreas and liver because of this. This has flared up again since December and I'm currently taking antibiotics for a possible infection in my bile duct. So... maybe there has been some inflammation or other issue that could affect the ferritin level results? I started the antibiotics after the last test, so it's not that.
I go to the same lab every time, so I don't think the results are incorrect or an issue with different machines/labs/ranges/calibration.
Hive mind, wtf might be going on?
Not interested in: comments or suggestions about the heavy bleeding. I'm onto it. Just need your thoughts on the ferritin situation!
Preface
I'm seeing my haematologist on Monday, but find I do better with some targeted questions or some possibilities to put to her. Hence this question!
Background
For the past three years, I've kept an extremely close eye on my iron so I can catch when levels are low enough to need a transfusion ASAP. I have blood tests after every menstrual cycle. In the past, I’d see ferritin decline steadily after every bleed until at around 100 ug/L I would be in full-blown low iron territory with a host of symptoms and need another transfusion.
I have non-alcoholic fatty liver which makes ferritin levels appear high on blood tests, despite symptoms of low iron. But I would expect to see symptoms at 100, not 200-plus.
I am now literally flooding for a couple of days at a time, changing a tampon AND period underwear hourly, sometimes still bleeding through my clothes. But ferritin remains bizarrely high at 200 over my last three cycles.
Directly after my last transfusion, eighteen months ago, ferritin was 347 ug/L, transferrin saturation 27%, transferrin 2.67 g/L and iron 18 umol/L.
Lab reference ranges are: Iron 8-30 umol/L, Ferritin 30-250 ug/L, transferrin 2.00-4.00g/L and transferrin saturation 10-35%.
My last three tests show ferritin between 200-218. Transferrin is also steady at between 2.59-3.0 g/L. Iron and transferrin saturation have dropped though - on the last test iron was down to 10 umol/L, and transferrin saturation to 14%.
Other possible issues: I had biliary dyskinesia about 18 months ago and a host of issues with my pancreas and liver because of this. This has flared up again since December and I'm currently taking antibiotics for a possible infection in my bile duct. So... maybe there has been some inflammation or other issue that could affect the ferritin level results? I started the antibiotics after the last test, so it's not that.
I go to the same lab every time, so I don't think the results are incorrect or an issue with different machines/labs/ranges/calibration.
Hive mind, wtf might be going on?
Not interested in: comments or suggestions about the heavy bleeding. I'm onto it. Just need your thoughts on the ferritin situation!
Just need your thoughts on the ferritin situation!
If you haven't been screened for it already, you should ask the hematologist to test you for hemachromatosis to rule that out as an explanation. It's a simple blood test.
posted by mandolin conspiracy at 6:58 AM on January 21, 2023
If you haven't been screened for it already, you should ask the hematologist to test you for hemachromatosis to rule that out as an explanation. It's a simple blood test.
posted by mandolin conspiracy at 6:58 AM on January 21, 2023
Are you taking any new supplements? Biotin, which is usually in multivitamins, can give falsely elevated ferritin levels.
posted by Pretty Good Talker at 7:36 AM on January 21, 2023
posted by Pretty Good Talker at 7:36 AM on January 21, 2023
Inflammation and infections cause release of ferritin. When I had a severe pneumonia mine went up to about 450 from a normal less than 20, and I had low iron on blood tests. Maybe you have some kind of chronic inflamation.
posted by lookoutbelow at 10:50 AM on January 21, 2023
posted by lookoutbelow at 10:50 AM on January 21, 2023
This thread is closed to new comments.
Your body has a number of responses which keep iron away from pathogenic bacteria during an infection, one of which is raising levels of ferritin.
So I think it’s reasonable to guess that the infection in your bile duct has caused the ferritin rise that you see.
However, if I’m reading your question right, you usually show higher than normal ferritin levels than would be expected in someone experiencing symptoms of iron deficiency, when you have those symptoms, because of non-alcoholic fatty liver disease.
A very recent study has linked gut bacteria that produce ethanol to such liver disease: Ethanol-Making Microbe Tied to Nonalcoholic Fatty Liver Disease .
In Europe, the culprits seem to be a Lactobacillus, but in China Klebsiella are the main suspects.
posted by jamjam at 3:57 AM on January 21, 2023