weird anemia panels & CBC

Can anyone help me out? I'm having a hard time understanding what's going on, and my PCP doesn't know what's going on (so i was referred to a hematologist/oncologist that 'doesn't know what to tell me')

I was first diagnosed with a pretty bad b12 deficiency in April 2010.
CBC was normal
no anemia panel was done
folic acid was normal.  

The b12 was re-run in June 2010 and was still very low. I started having b12 injections 1 x every week for a month, and then 1 x a month from then on. But eventually switched to Nascobal (b12 nose-spray) when my body couldn't handle the injections. I am still to this day doing weekly b12 spray's.

In November 2010 b12 was still low, but getting higher.
CBC was normal.
iron serum-low
unsaturated IBC- high
calculated toal ibc- normal
calculated % iron saturation- low
ferritin- low

In February 2011
iron serum- Normal
Unsaturated IBC- high
calculated total IBC- high
calculated % iron saturation- low
ferritin- very low
b12- normal

March 2011
MCHC- low
band % - low
TIBC- high
calculated iron saturation- low

June 2011
RBC- low
HCT- low
MO%- high
(no anemia panel was run, cause the hematologist/oncologist is a dummy and gave up)

July 2011
Iron serum- normal
Unsaturated ibc- high
calculated total IBC- normal
calculated % iron saturation- low
RBC- high
MCHC- low
b12- normal

I know it's a lot to read but;
Can anyone PLEASE help me understand what's going on?
How can my RBC go from being too low to too high?
I can feel something is going on, but doctors turn the other cheek cause it's 'too complicated' to tell what's going on.
Does anyone have ANY ideas?
:(

[mkh9]

Well, I think you do have an iron deficiency anemia but I don't know why the RBC count is fluctuating. When the %saturation is low then you will be very tired as the % of iron in the RBC is not binding. Classic iron deficiency is low ferritin, high TIBC low hemoglobin or hct. The RBC's may be fluctuating from being normal or high to low because you have anisocytosis and Poikilocytosis which makes your RBC's vary in size and shape and may distort your reading that you get from an automated CBC. You could be losing blood via a heavy period or not enough Iron in your diet, also a bleeding ulcer, hemorrhoids and other problems can cause iron deficiency anemia. You can take over the counter iron pills but  you will have to get tested in about three months because you don't want to get a high iron level as this is very hard to get rid of. Then every 6 months you should get a TIBC, percent Iron saturation and Iron level and a CBC. But I would see another hematologist as this one isn't good. I hesitate to tell you to take a certain amount of iron without a doctors supervision. It is good if you can get to the root of the problem. I was iron deficient too and it took months to get the iron back in my bone marrow. I assume you are extremely tired. The B12 will not help with iron deficiency.  You don't want to get Iron over load.  But I think that taking ferrous gluconate (absorbs better) daily or ferrous sulfate would help you.  Once you get a normal iron level and the percent saturation is going to be low still then once that is normal you can stay at that amount of iron intake. But you will still have to be monitored. If you stop taking iron and then wait a few months your iron will probably drop back down. So watch out for doctors also telling you when you are on iron that you are "normal". Because it will change and it has  to monitored. I will add also that your hemoglobin or hematocrit won't be low until you are in 3rd stage anemia. i was normal but my iron was low and percent saturation very low I was in 2nd stage Iron deficiency anemia. I was exhausted. let me know if you have any questions.

[mkh9]

Hi again,
I also read (see below) that if you are taking a proton pump inhibitor like Prilosec (Omeprazole) you will not absorb both iron or B12. So, that is my question, are you on this for stomach problems like GERD? If so you won't be able to absorb the iron well and also the B12. If you are not on a proton pump inhibitor you could have pernicious anemia. I will check into that and get back to you. Let me know about the proton pump inibitor.

B12 and Iron Deficiency
Medical studies suggest that some of the medicines used in the treatment of GERD can result in vitamin B12 and iron deficiency. According to the NIH's Office of Dietary Supplements, proton-pump inhibitors, like omeprazole and lansoprazole, can inhibit B12 absorption, since stomach acid is necessary for the absorption of this nutrient. They recommend monitoring of B12 levels in people taking proton-pump inhibitors for prolonged periods of time. According to the American Academy of Family Physicians, stomach acid enhances the absorption of iron from the small intestine. They recommend avoiding medicines that reduce stomach acid if you are taking oral iron supplements to help correct iron deficiency anemia.

mkh9

[blingblingbubbaa]

Thank you so much for your response!!

The weird thing is, i have only had two periods since dec 2009 (my birth control has messed up my cycle), so i am not losing blood that way. I had a colonoscopy/upper scope in may and there was no bleeding, just granulomatis gastritis. And they were unable to  find any hemorrhoids. No, i am not on a proton pump inhibitor.

I have been taking bifera (iron pill) for the last 5 months, although i can only take it every other day, cause it messes with my stomach.

I never knew there were different stages of anemia! Would you be able to explain that to me, Please? :)

[blingblingbubbaa]

Ps. would they be able to look for the anisocytosis in a peripheral blood smear? I'm trying to convince my PCP to do one, to see if there are any abnormalities in the sizes of my cells.

[mkh9]

Hi blingblingbubbaa,
You can take Ferrous gluconate or slow iron, or even ferrous sulfate (thought it doesn't absorb as well). I was taking Ferrous gluconate but now years later still take ferrous sulfate. I only need 2 days on and one off now. Before I had to take two 5 gram pills a day. Yes there are different stages of iron deficiency anemia. Stage I, you have low ferritin, TIBC is high normal (high end of normal range), serum iron is low normal. Transferrin saturation is low normal, free erythrocyte protoporphyrin normal, bone marrow sideroblast normal, hemoglobin normal, MCV normal, RBC morphology normal.
Stage II. low ferritin, TIBC is slightly higher than normal, Iron is low, transferrin saturation is low, free erythrocyte protoporphyrin high, marrrow sideroblast, low, hemoglobin, normal, MCV is normal and RBC morphology is normal.
Stage III. low ferritin, TIBC high, iron low, transferrin saturation low, free erythrocyte protophorphyrin is very high, marrow sideroblasts, low, hemoglobin low, MCV is low, RBC morphology is microcytic hypochromic.
So it is based on the CBC and Iron results etc. which stage you are in. They normally do a automated CBC not the manual microscopic until the results come out abnormal then they read the slide by hand.  They will do one if the doctors asks. My hemotolgist had his own lab and they automatically did a manual microscopic slide test for all CBC's. Good luck with all this. I hope you feel better soon!
mkh9

[blingblingbubbaa]

The bifera is neither of those. It has PIC (polysaccharide iron complex and HIP (heme iron polypeptide as proferrin). Although it does not seem to be working since i am still anemic. I saw my PCP a few days ago, and she says i do have anemia, but since i don't have problems with my MCV it isn't anything 'scary'. I believe it is weird though, since i am not having periods and have no bleeds in my stomach. I am not vegetarian, and will eat red meat about once a week and will eat veggies and other foods with iron in them daily (i've even gone to the extreme and ate liver!). Another thing i am experiencing with this, is my spleen is almost always very swollen and very painful after i eat (my stomach will get distended) and painful if i push on it. I have had EBV (5 years ago), so i know it is not swollen from that. I also asked my PCP if she can do a blood smear, but didn't see the need to. She did however tell me to go see another hematologist/oncologist. Thank you so much for reading my post and answering my questions! :)