FerritinFilter: YAN my doc, but I'm supposed to have septoplasty & turbinate reduction on Monday, and my ferritin is back to the very low end of normal. Ok to go?
May 14, 2010 3:25 PM   Subscribe

FerritinFilter: I know YAN my doctor, but I'm supposed to have a septoplasty & turbinate reduction on Monday, and my ferritin is back to the very low end of normal. Ok to go?

So yeah, if you've had a surgery with low ferritin and your doc said that was fine, I'm just curious. If you want more details, they're below, but that's up to y'all.

I am an adult male, age 38, 5'10", 158.

Several nurse folk who've looked at my pre-op bloodwork stuff think this is ok - it's the only thing that's near outside of 'normal' (16) - although the doc who is going to do the surgery probably won't see it until I'm in the waiting room. (Yeah, why did I wait so long for the draw? I wanted to see how high the ferritin was up to before getting in there). I've been all over the country seeing a variety of folks regarding some weird stomach/g.i. problems I've had over the last couple of years, but all diagnostic tests that i've had done so far have been negative, including every scope-style test there is. Biopsies have shown nothing of significance. I've tried just about all the proton pump inhibitors and holistic type substances to no effect, also done tai chi & yoga, acupuncture.... I'm already super-vigilantly gluten-free (6 years) and discovered last year that if i took a double dose of Floravital liquid iron, I was able to get my ferritin level up to around 70-80. I went down to a single dose for Dec 09, and after a month it was back to around 12. I can absorb b-12 and take a big 2500mcg sublingual tab a few times a week. So from Jan to now, I doubled up the dose of the liquid iron again, and it appears that now it's not doing a whole lot (who knows, maybe it would be lower than normal if wasn't taking it). I have Hashimoto's and have been on t4 for years, more recently also t3, but s'far as I know that does not impair iron absorption.

I had a bunch of tests done last summer (no bone marrow yet, tho) at a hematologist's office, and he didn't find anything of note. About two years ago I noticed that I started scarring more easily, but he did not make much of that.

A couple docs said "well, you must be bleeding somewhere internally, we just can't see it" but beyond that, they just scratch their heads as to cause.

I eat a pretty decent diet (although I eat no yeast or dairy anymore, in addition to no gluten) and have always been in pretty good shape, etc. However, due to allergy/sinusitis on top of the stomach stuff, not breathing much out of one nostril has become really annoying and might be affecting my sleep. I've also been on immunotherapy for years... without it I'm 100% miserable with the drainage. Tried all the steroid nasal sprays, some of which used to work but now seem to do nothing or very little, and I do the sinus rinsing every day, which does help but not overnight. Antihistamines help a little.

So. That's the tale. I have mysteriously low ferritin which now appears to not be going up again with iron supplementation. Yes, I will see more docs about the iron absorption, for sure - I'm just checkin' to see if this is a really stupid idea.
posted by anonymous to Health & Fitness (7 answers total) 1 user marked this as a favorite
In the absence of anemia (low hemoglobin) the low ferritin is of uncertain significance. There is some debate as to whether this even means anything at all. I'm assuming when you say that all of your other blood tests are normal that you are not anemic. You also sound like you have had a full hematologic workup (unclear if this was even necessary).

Re your immediate question about surgery: The low ferritin is very unlikely to put you at higher risk of complications.
posted by madokachan at 4:46 PM on May 14, 2010

Sorry I can't help about the ferritin, but having had the same op. last year don't believe anyone who says you'll be back at work in a few days. You may be, but I was wiped out for 10 days, in case you had anything big planned. Also get in industrial quantities of tissues and one of these - the magic mix is just 50% sea salt and 50% baking soda at 1tbsp/l, but the bottle shape is unbeatable for gently getting rid of the insane amount of *horrible* stuff that will appear over the next six weeks (once you've healed a bit; get a doctors OK before you start flushing). Oh and prep any significant other that you'll be like a bear with sore head for a while, you won't be able to breathe through your nose for a week at least, and your breath will smell, well, like a bear with a sore head.

Not trying to freak you: it's worth it, but I felt I was underprepared by my surgeon for the recuperation period.
posted by cromagnon at 5:51 PM on May 14, 2010

Disjointed thoughts:

For what it's worth, my serum ferritin of 10 (ng/mL) didn't even get flagged as abnormal on my lab sheet. There are different reference levels, and my lab used 10-291 as normal for women. [Although my doctor and I are treating it anyway, because it seemed to be leading to fatigue.]

Also, I've read recently that lower ferritin levels have something of a preventive action against infection. In theory, this could be an advantage during surgery, but I am neither your doctor nor a doctor.

Proton pump inhibitors might be decreasing your absorption of iron because they're decreasing your production of stomach acid. (They mention this here.)
posted by needs more cowbell at 5:58 PM on May 14, 2010

The very low end of normal is normal. Normal values don't mean, "If you're not normal there's something seriously wrong with you!" They just mean plain old normal. I don't think the doc would be worried even if your ferritin was below normal, so long as your other labs are good and you're not displaying signs of anemia.

I'm assuming your other lab values are normal. Especially important is your hemoglobin/hematocrit. As far as I know, ferritin is a useful value for anemia differentials, but not for much else.

Low ferritin can be indicative of other problems-- vitamin C deficiency, and, notably, hypothyroidism.

It's doubtful that your ferritin levels have anything to do with anemia. Hashimoto's is a much more likely explanation. If it's due to Hashimoto's, then it's a bad idea to be worried about anemia. I want to explain why.

Ferritin is an iron binder. When you have higher iron levels, your body makes more ferritin. This is why ferritin is associated with anemia-- if you don't have enough iron, your body isn't going to make as much ferritin. Why do you need to bind iron? Because lots of pathogens love high-iron environments. You don't want to encourage those pathogens. If you have lowish ferritin levels for a reason other than iron deficiency, and you treat assuming it's because of iron deficiency, then all you do is encourage infection.

It sounds to me like a doctor (maybe more than one) made an off-hand comment, pondering your situation, and then forgot to clarify when more information was known. That's because a bleed is a reasonable thing to suspect in the presence of stomach troubles like the ones you describe. But a bleed is serious, so you check it out, probably with endoscopy, which you indicate you've, umm, had the pleasure of.

Low ferritin levels in the absence of other diagnostics aren't evidence of a bleed.

This is all said in the assumption that your H+H is normal. A low H+H would be good reason to proceed cautiously with surgery.
posted by nathan v at 6:09 PM on May 14, 2010 [1 favorite]

Almost missed this part:

I've also been on immunotherapy for years....

What exactly do you mean by immunotherapy, and what is the exact indication?

(Other health conditions affect things that you might not be aware of. When you get advice in threads from these, even advice from other health professionals, it's usually in the assumption that you have given us a complete list of your medical problems. If you haven't, people can give bad advice, even dangerous advice.)
posted by nathan v at 6:17 PM on May 14, 2010

Seconding everything cromagnon said. I don't know about the ferratin, but I had a septoplasty & turbinate reduction a few years ago (in addition to some other stuff done at the same time) and I too was unprepared for the healing period. Not as painful as I anticipated, but having your nose packed is extremely uncomfortable, and I recommend getting an elastic band to hold the gauze under your nose instead of taping it to your skin. Also, stock up on your favorite chapstick--days of mouth breathing gave me very chapped lips. Good luck!
posted by inertia at 8:22 PM on May 14, 2010

Simple anecdote. I had surgery a month ago, with a ferratin of 3, hemoglobin of 9.2 and a whopping 30 on my crit. I don't feel so hot just yet, but the surgery was not one that required a great deal of blood loss, and I have been recovering just fine with my iron supplements taken twice daily. Good luck.
posted by msali at 8:49 PM on May 14, 2010

« Older Bumblebees: so cute, but so ouchy   |   I Accidentally Played with the Big Boys and Won Newer »
This thread is closed to new comments.