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  • I have iron deficiency anemia. What is causing it?

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    Old 07-26-2013, 12:53 PM   #1
    Erik2K13
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    I have iron deficiency anemia. What is causing it?

    After noticing a recent decrease in my athletic performance, I sent a message to my doctor early last week. My primary care physician ordered blood work and sent me to a hematologist in oncology. The hematologist said it was "very unlikely" cancer and ordered more blood work. Further blood work confirmed I have iron deficiency anemia.

    All my blood work was normal apart from the indices related to iron deficiency. Ferritin was low, indicating iron deficiency and not anemia of chronic disease. Bone marrow is producing a normal amount of red blood cells. I have not recently donated or lost substantial quantities of blood. I have not had any tarry stools or seen blood in my stool. A rectal exam was negative for the presence of blood. (This test involved a doctor inserting a gloved finger into my rectum and then testing the glove for blood.) I have no bruising and my blood clots normally. I have not seen any blood in my urine. I have no other ongoing health conditions.

    For the last 5 years, I have run 52 miles a week. I eat very little red meat, no more than a few times a year. I do regularly eat poultry, fish, and eggs. I have had semi-frequent nose bleeds, averaging one a month, since childhood.

    The hematologist put me on a high potency iron supplement -- 130mg of iron and 250mg of vitamin c per day.

    All my doctors have discounted the possibility the anemia could have been caused by my running, despite there being ample evidence in medical journals that excessive exercise can lead to iron deficiency.

    If it's not cancer and i'm not losing blood through my gastrointestinal tract, what is causing it? I do feel improved since starting the iron supplement on Monday, but my athletic performance is not where I'd like it to be. I don't have any further doctor visits scheduled at this time. I am to have blood work in 1-2 months to test my iron levels again.

    My blood work is below:

    IRON 24
    TOTAL IRON BINDING CAPACITY 380
    IRON/TOTAL IRON BINDING CAPACITY 6%
    FERRITIN 5.6
    VIT B12 549
    FOLATE 17.62
    RETICULOCYTE COUNT, ABSOLUTE 2.5

    WBC'S AUTO 3.4
    RBC, AUTO 4.52
    HGB 10.6
    HEMATOCRIT 34.2
    MCV 75.6
    MCH 23.5
    MCHC 31.0
    RDW, BLOOD 18.0
    PLATELETS, AUTOMATED COUNT 206
    MPV 8.7

    CHOLESTEROL 127
    HDL 43
    CHOLESTEROL, NON-HDL 84
    TRIGLYCERIDE 48
    LDL 74

    HGBA1C 5.4

    GLUCOSE POST FAST 87
    BUN 21
    CREATININE 1.2
    TOTAL PROTEIN 6.6
    ALBUMIN 4.8
    GLOBULIN 1.8
    ALBUMIN/GLOBULIN RATIO, SERUM/PLASMA 2.7
    CALCIUM 9.4
    AST 21
    ALKALINE PHOSPHATASE 51
    BILIRUBIN, TOTAL 0.8
    LDH 157
    PHOSPHATE, BLD, QN 4.2
    URIC ACID 5.3

    TSH,BLD,QN 1.680

    Last edited by Erik2K13; 07-26-2013 at 01:02 PM.

     
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    Old 07-27-2013, 09:39 AM   #2
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    Re: I have iron deficiency anemia. What is causing it?

    The only thing I can think of in your case would be Runner's Anemia. I think your Dr's could be wrong in this case especially with the amount you are running and the little red meat you are eating. Anemia is very common in runners, and not very common in males so in my personal opinion it is really the only thing that makes sense which is why I'm kinda dumbfounded that your Dr's would think it's not caused by running. Your numbers are not very good which would explain why you are not feeling to well.

    There is one other thing I can think of, have you been checked for Celiac's "Gluten Intolerance". I seriously think it's from the running myself.

    Last edited by Heatherx5; 07-27-2013 at 09:42 AM.

     
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    Old 07-27-2013, 12:34 PM   #3
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    Re: I have iron deficiency anemia. What is causing it?

    I've never been tested for Celiac's and that's something I can raise with my doctor if my iron levels don't improve when I have blood work again in 1-2 months. I don't seem to be exhibiting any of the symptoms of Celiac's besides anemia, however. Notably, my calcium is normal and that would likely be off if I had Celiac's. I also have not experienced any unintended weight loss, rashes, bruising, joint pain, or diarrhea.

    I do wonder if my doctor's are simply unfamiliar with anemia in runners. My hematologist specializes in oncology, so perhaps it's not something she sees often.

    Last edited by Erik2K13; 07-27-2013 at 12:35 PM.

     
    Old 08-07-2013, 10:55 AM   #4
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    Re: I have iron deficiency anemia. What is causing it?

    I think a specialist would be a good idea. I haven't found many Dr's that are really familiar with anemia in general and I did a lot of studying on it myself and could not believe how common it was in people that ran. You would think that would be the first thing he assumed!

     
    Old 08-16-2013, 09:17 AM   #5
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    Re: I have iron deficiency anemia. What is causing it?

    True! The nih.gov fact sheet on iron says that intense exercise, particularly distance runners, often have inadequate iron status. However, though there are theories, there isn't a definitive answer for why this occurs. Perhaps doctors tend to discount it for that reason.

    I've been on oral iron supplements now for 3 and a half weeks and I am seeing significant improvements. The palor of my skin has improved, exercise tolerance has increased, and my general energy level is much higher. I knew my exercise tolerance had decreased, but I was unaware just how much the anemia was affecting all facets of functionality. I feel better now even during everyday tasks and am refreshed after sleeping. I have no doubt that i'm improving.

     
    Old 08-16-2013, 09:47 AM   #6
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    Re: I have iron deficiency anemia. What is causing it?

    The iron deficiency could certainly be related to dietary insufficiency since you eat very little red meat. Of interest is your low WBC. I would ask to have that repeated with followup tests and if it is persistently low, would also consider autoimmune disorders, such as early lupus, if you have no other symptoms. Also, do you have heavy periods? Usually runners do not, but that can be a source of anemia too. It is possible to have celiac disease without any symptoms other than anemia. Antibodies (anti-endomysial and anti-transglutaminase) could be checked on next blood tests to rule that out, although they are not 100% positive in celiacs. I would also ask for a urine to check for microscopic blood that can't be seen.

    Last edited by ladybud; 08-16-2013 at 09:49 AM. Reason: added

     
    Old 08-16-2013, 10:45 AM   #7
    Erik2K13
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    Re: I have iron deficiency anemia. What is causing it?

    First, I don't have periods because I'm male, LOL. Believe me, a male who has anemia really sets off alarm bells for a doctor. They've been very concerned...

    None of the doctors I've seen (currently 5) thought my white blood cell count was of particular interest. In 2007 it was 4.3. In 2011 it was 4.0. At 3.4, the results listed above were slightly out of range. However, blood work done by a different lab a few days later had my WBC at a more normal 4.7. Because the results over a 6 year period are all within a fairly narrow range, that is not something they've expressed much concern over.

    Celiac seems unlikely because I'm not deficient in any of the other nutrients tested -- calcium, b12, or folate. If malabsorption was occurring, it seems implausible it would be confined to iron deficiency. None of my doctors have mentioned celiacs as a possibility.

    I think a urine test should be performed for hemoglobinuria. A higher than normal concentration of hemoglobin in my urine could indicate red blood cells are being destroyed during foot strike while running. A urine test is one thing that no one has performed.

     
    Old 08-16-2013, 08:24 PM   #8
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    Re: I have iron deficiency anemia. What is causing it?

    Oh, ha,ha, bet you laughed at that one! So sorry! If you do have microscopic blood in urine, I would not assume it is from running. I would get at least an ultrasound or CT scan of urinary tract to rule out anything more serious.

     
    Old 08-16-2013, 09:59 PM   #9
    Erik2K13
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    Re: I have iron deficiency anemia. What is causing it?

    Absolutely. Though I'm not sure how much more it'll be investigated if my numbers have all jumped up the next time I go in for blood work. I'm pretty confident my hemoglobin and hematocrit are up substantially. My exercise tolerance has improved significantly. If my numbers move into a normal range, there'll be little reason to continue looking for an answer to a problem that no longer exists. All my other blood work was normal and I still have no other symptoms.

    There is a pattern of decline in my hemoglobin and hematocrit that correlates strongly with the running. I've always run some, but only in the past 5 years have I started running 7+ miles every day. In 2007, before I started running my daily 7.5 miles, my hemoglobin was a robust 16.7 and my hematocrit was 48. By 2011, my hemoglobin had dropped to 13.4 and my hematocrit was 42. However, no one ever notified me there was such a drop and my iron levels were not checked at that time. Then last month, my hemoglobin tested at 10.6 with my hematocrit at 34. The pattern is indicative of a steady decline. At the very least, the decline has stretched over 2-3 years.

    Regardless, I'll definitely keep the board updated on my progress!

     
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