Aa
Aa
A
A
A
Close
495402 tn?1220617403

Doctor Recommending Iron Due to Anemia

My doctor called last night to say that my blood levels came back border line and I also have anemia.  I sort of guessed that due to constant fatigue.  I'm telling you, I could fall asleep almost anywhere these days.  She told me to start taking iron, 300 - 325 milligrams a day.  I have six months left to go, I will be doing shot number 25 tomorrow night.

I'm not at all happy about this, isn't iron supposed to be bad for the liver?  Not to mention the constipation and stomach distress.  I'm already having a hard time in that area and I'm taking Colace and Benefiber.

Anyone have any thoughts on this, will Iron help me feel better, will iron harm my liver?  Is anyone else who is on treatment currently taking iron?

Linda
22 Responses
Sort by: Helpful Oldest Newest
Avatar universal
You asked if anybody had been told to take iron supplements while on treatment.  I got badly anemic around week 8 during and just after having my period.  The physician's assistant said that if I'd been eating a low-iron diet (which I had been), I should change my diet to increase the iron content.  She told me not to take iron supplements because the dose was too high.  She also said that while I could get away with an iron increase at stage 1, someone with a worse-off liver might not be able to.  My hemoglobin went up after the diet change, before it plunged a few weeks later from the ribavirin.  From week 12 on, it stayed at the very low end of normal for the rest of the treatment.
Helpful - 0
Avatar universal
it is called  vit b-12 folate and usually done with ferratin tests.  

that would be up to you and your doc. what your labs say.   I am not on any b12 supplements,  So for me,  I don't want a b12 overload.

Deb
Helpful - 0
233616 tn?1312787196
sorry that should have been www.labtestsonline.org
Helpful - 0
233616 tn?1312787196
your free transferrin determines whether you need iron while on procrit.

It's not a simple yes or no because hemolytic anemia means you haven't got enough red cells. No amount of iron alone will change that, and too much iron will cause oxidative stress and can lead to free radical formation and tumor necrosis.

However, if you take procrit to increase your red count and have NO free iron, no iron for those cells to take up as they form, then they simply will not form. Therefore you may be told to take iron, although eating a little more red meat, cashews, sesame butter etc is a safer way to get a little iron without going overboard or harming your intestines which most pill forms do tend to cause.

Each week my HGB goes up from the procrit about 1 or 1.5 points, and then down again as the tx kills them off. So I'm maintaining a HGB of between 10 and 11.5
What you want is to try to get to that maintainence level, where your number is not still dropping.

If your doctor cannot explain all this to your satisfaction, and provide you with copies of your labs, I asked to be referred to a hemotologist for the blood maintainance as it's important not to go overboard with the iron.
My ferritin (fixed iron) level has gone from 500 down to 50, because I watch my iron AND because my liver is working better after 76 weeks of tx, THIS IS GOOD news according to my liver doc.

my free transferrin (free for cells to take up, as opposed to ferretin(iron already in the cells) I try to keep between 200 and 300 so that the procrit will have iron to work with.

Even if you try it's hard to avoid all iron intake because it's in everything, about 5% is average, but you will also not take up all you eat.
If your ferretin level is too high you can gradually bring it down with dietary awareness and as the tx improves your liver functions, but you need to balance that need with the need to have blood to carry oxygen, and iron is an integral part of how those cells are formed.
The reason ultimately you want to see your ferretin go low and be kept low is because excesses tend to be laid  down and stored in the liver, where they do what all iron does, they turn to rust, and this aggravates the liver cells and is considered the main cause of liver necrosis (cell death) as well as liver tumors.
The reason you may need to take some iron would only be if your labs showed no free transferrin available so the procrit, or your bone marrow on its own could do their jobs.
In other words, if you are trying to build a house you need some material to build with, and iron is an essential building block to produce red blood cells, without which you cannot carry oxygen to the cells, and will eventually suffer major organ damage and even die. On the other hand, too much iron can also cause great illness. The trick is to learn to understand your own labs, and your own doctors reasoning so you won't worry.
I've found most of the nurses and tech do NOT understand the iron labs nearly as well as they should, and learned more in here than from them.
So don't get too worried or upset, just go back to your doctor, get a full explaination, and keep reading and learning like you have been. It'll be OK. Try going to labsonline for good explainations of the various labs.

mb

mb
Helpful - 0
691935 tn?1421027090
what test was run showing high B12 levels?  I thought B12 was good for you on tx?  Stacie
Helpful - 0
Avatar universal
don't forget thalassemia  Some in my family have that.

http://en.wikipedia.org/wiki/Thalassemia

they are unable to take Iron in anything but  a natural form.

So yes there are many forms and causes anemia.

Get all your iron tested and get repeats, I do.

Deb


Helpful - 0
Avatar universal
There are more than 2 types of anemia,

iron-deficiency anemia
hemolytic anemia
aplastic anemia
pernicious anemia
folate deficiency anemia
beta thalassemia anemia
sickle cell anemia
    
Helpful - 0
Avatar universal
the other option  is lowering riba,  i was over my weight base so they lowered it it, to weight based!

But I was I had been treating for a long while,    do get levels tested,  
Helpful - 0
Avatar universal
Dang, I hate when malfunctions happen as with brain and finger correlations and the missing verbiage and grammar. : )

jasper
Helpful - 0
Avatar universal
Hey! You had an organ malfunction, something went whacky at weeks 22 or 24, it happens and for you, it was later, rather than sooner, this is a good thing. You have made it this far without procrit and it seems that your system is working real hard to make them red blood cells that the Riba is chewing up at a faster rate that can be made by itself and there is nothing wrong with taking iron and for a short time to build them back up. I took iron and vitamin c for 6 weeks and then stopped because the malfunction corrected itself during that time. Look at it this way it took 24 weeks to deplete the normal stores and your declining HGB proved that and now that the cloth is falling your needle and thread is short so you have to spin a little more with procrit as the helper and the iron is the essential ingredient to get the marrow producing higher than normal amounts of red blood cells. The doc was correct to put you one the iron before starting the procrit and she will tell you to stop when the levels are in range. It is a little nerve racking of the unknown but will be fine, just keep moving forward and stay positive.

jasper
Helpful - 0
Avatar universal
Yes to true,  My HGB kept sinking. I was already on 60k of procrit.  Jim suggested a  iron test, they also did, and a vitamin b12, levels were high.  Ferratin a nd vit Changed diet a bit, procrit is again now effective,  Remember also there are 2 kinds of anemia,  regular old fashioned and for us the more complicated one.  

Good luck!

Deb

Helpful - 0
Avatar universal
Many doctors make the mistake of prescribing iron on treatment when it's not necessary and in fact counter productive. Heed the advice you have been given here.

1. You want your own copy of all your blood tests, and specifically: serum iron, Ferritin, TSAT (Transferrin saturation).

2. Unless your Ferritin and TSAT are low, then you probably do not need iron regardless of a borderline serum iron test.

3. What kind of doctor are you treating with? I doubt a hepatologist (liver specialist) would prescribe iron incorrectly, but it's not surprising that many gastroenterologists or family doctors would.
Helpful - 0
Avatar universal
Can you get hold of the hard copy of your results and post them?

If your doc is on top of her game and has a valid reason, she should take time to explain why it's not simply a question of adding Procrit for hemolytic anemia. It seems so out-of-the-ordinary.
Helpful - 0
495402 tn?1220617403
Thankfully, I am not pre-treatment, luckily, I am coming up on my 25th week out of 48 of them, but I do intend to speak with the doctor regarding why she thinks I should be taking anemia and whether or not the Ribaviran is causing it.  Yes, I'm fatigued and like I said, can fall asleep almost anywhere, a first for me, but I think I'd rather take my chances with the fatigue then take the iron, unless she thinks it's very necessary.

~Linda
Helpful - 0
Avatar universal
A lot of GIs are now testing for anemia pre txing,   as ms said get the tests, if you have already and he is recomending some iron , follow his direction, I had a problem earlier in tx, with this.  

Good advice mekea

Best of luck!
Helpful - 0
495402 tn?1220617403
Yeah, this is what I thought, that's why I don't plan on taking it unless the doctor can give me a good reason why.  I do not have to worry about menstrual periods, I had a full abdominal hysterectomy a few years back due to cervical cancer, so that's out.

I have a call in to my doctor for her to call me, I want to find out exactly why she thinks I should start taking iron.  It's odd because when I first started treatment and my platelets and WBC started dropping, anemia came up in the conversation and she said that if I ever became anemic, she would most likely put me on Procrit.  My liver doctor is a gastrointologist.

On the whole, treatment hasn't been all that bad for me, the first shot was the worst and then again, it really wasn't all that bad; at least not what I expected.  I manage to work a full time job and get myself to work everyday, getting up at 5:00 am, I have a long commute.  I am finding that the 2nd half of treatment is a little more trying, tired all the time, some strands of hair starting to fall out, mouth irritations, like cankers, etc.  It's no walk in the park, that's for sure!

I'm going to stay away from the iron until I hear some good reasons why it's okay to take.

Many thanks for all your replies!
Linda

Helpful - 0
179856 tn?1333547362
If your anemia is hemolytic anemia Meakea is correct - iron won't help and it may do harm."


If you are not truly UND taking iron could help the virus begin replication as it is an essential ingredient of the process.

Typically we are given Procrit (or Epogen generically) to combat the hemolytic anemia which is quite common. I had anemia quite drastically and the Epo was able to help me. Iron doesn't combat the hemolytic anemia and is only REALLY necessary if your iron STORES are low. Big difference in the two things.

If I was you I would get copies of ALL of my tests (this is something we constantly are encouraging people to do). Then you can look for yourself and see what the real story is. I'm surprised that your doctor wouldn't know the DIFFERENCE.  There is a huge difference between anemia caused by interferon/riba and anemia that you get in regular life.

Call and get those results faxed over (or go pick them up) and then post which number the doctor is looking at to determine "iron".  Still..........I wouldn't take iron for the life of me on treatment it's not worth the chance that at week 24 there is still virus residing inside of you (even if it is not detectible in your BLOOD LEVEL it could be elsewhere).
Helpful - 0
Avatar universal
Is your doctor the one treating you for HCV or your primary care physician?

My PCP ran some annual tests on me independently of my hepatologist and wanted to call an ambulance when she saw my blood-work. My specialist considers those same numbers fine, with no need for intervention. I have hemolytic anemia due to ribavirin AND high ferritin, yet both are acceptable to my treatment doctor.

I remember someone here who had to take iron due to heavy periods but that seemed an exception.
Helpful - 0
9648 tn?1290091207
*If* it turns out that you should really be taking iron, there is a product called "Floradix" that comes in liquid or pills (you have to get it at a health food store). I believe it is German or Swiss. At any rate, you can take it without getting constipated. (The liquid tastes yucky so you might go for the pills.)
Helpful - 0
Avatar universal
One of the most common symptoms of treatment is anemia, but generally speaking it is hemolytic anemia which can be present even with abundant iron stores.

On the other hand if you are a pre-menopausal woman it would be quite possible that you are anemic due to low iron.  Post-menopausal women often have iron stores comparable to men.

We cannot tell you one way or the other without scores but I would make sure that your iron panel suggests that you need iron.  If your iron is in range and the anemia is hemolytic (very common during TX) I don't believe that taking iron will help you.

You may double check with the doctor and many of us as a matter of course ask for copies of labs.

Best,
Willy
Helpful - 0
Avatar universal
What type of doctor is treating you?
Have you been tested for iron?

Iron tests are:

Serum Fe        
Total iron-binding capacity (TIBC)
Transferrin saturation

Without results from these tests I don't see how anyone could know that you are iron deficient.

If your anemia is hemolytic anemia Meakea is correct - iron won't help and it may do harm.

Generally anemia during treatment is assumed to be hemolytic anemia due to Ribavirin. If there is doubt there are tests used to diagnose hemolytic anemia - reticulocyte, coombs' and haptoglobin tests.

Mike
Helpful - 0
Avatar universal
The whole iron thing is certainly a confusing issue.  There are some old posts that go into this and most of them say to stay away from iron.  However, there are times when iron is necessary -- it depends on what the patient's situation is.

It's been my understanding that iron won't help the hemolytic anemia caused by the Ribavirin....but if you're prescribed Procrit and you don't have enough iron stores, the Procrit won't work.  On the other hand, anemia from blood loss is treated with iron.
Are you having heavy menstrual periods that might be contributing to your anemia so that this might be why your doc wants you to take iron?

I really don't know the answer and I hope someone else does because this is always a confusing topic.  In the meantime, I would suggest that you call and ask you doc specifically why he thinks you need the iron -- not just that your anemic -- but WHY he thinks the iron will help your anemia that is most likely caused by the riba.  
Helpful - 0
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.