Good Info on procrit and Iron

I wanted to share this info with all of you,  it is something I have been challenged with the last couple of weeks.
because while some of you may never cross this bridge, it really helped me clear up some confusion about iron.
Basically,  I will try and keep it brief.  I can't keep my HGBs up,   i wanted to increase my Procrit,  but  was told after 60 which I am already on,  I am 1a,  third time treater,  looking at 72 weeks on infergen.  I have been adamant, I will get there.  Riba was the answer, lowering it was not the answer,  I have reported all that on the other side,
I got some really good info  from some of the folks  here,  things i never knew. Another avenue to explore, to present to my GI.
I

80 probably won't make any difference, as the effectiveness of Procrit seems to max out at 60.

Did they do any iron store tests -- specifically Ferritin and TSAT? Sometimes iron stores get reduced with epo and if so, the epo will stop being effective. The remedy is supplemental iron, but only if iron stores are low. http://mesomorphosis.com/downloads/uspi-epogen.pdf


"Lack or Loss of Response
If the patient fails to respond or to maintain a response to doses within the recommended dosing range, the following etiologies should be considered and evaluated:
1. Iron deficiency: Virtually all patients will eventually require supplemental iron therapy (see IRON EVALUATION).
2. Underlying infectious, inflammatory, or malignant processes.
3. Occult blood loss.
4. Underlying hematologic diseases (ie, thalassemia, refractory anemia, or other myelodysplastic disorders).
5. Vitamin deficiencies: Folic acid or vitamin B12.
6. Hemolysis.
7. Aluminum intoxication.
8. Osteitis fibrosa cystica.
9. Pure Red Cell Aplasia (PRCA) or anti-erythropoietin antibody-associated anemia: In the absence of another etiology, the patient should be evaluated for evidence of PRCA and sera should be tested for the presence of antibodies to erythropoietin (see WARNINGS: Pure Red Cell Aplasia).

[jmjm530]

80 probably won't make any difference, as the effectiveness of Procrit seems to max out at 60.

Did they do any iron store tests -- specifically Ferritin and TSAT? Sometimes iron stores get reduced with epo and if so, the epo will stop being effective. The remedy is supplemental iron, but only if iron stores are low.
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I thought the bad grammar looked familiar.  I never asked for credit per my opinions, but if you're going to lift what I say word-for-word, maybe an attribution is in order :)

-- Jim

[portann]

Hi Deb,

I was bragging about Jmjm's insightful suggestion about this matter to my husband. The way I put it was that he really came at the problem from such an original angle, so original I didn't understand it at first.  But it did kind of blow me away, really thinking out of the box stuff.

I'm rooting for you that this will be the elusive solution to your HGB/procrit.

Hugs.

[nygirl7]

I thought the bad grammar looked familiar.  I never asked for credit per my opinions, but if you're going to lift what I say word-for-word, maybe an attribution is in order :)
---------

Jim if we start crediting all the credit we'd owe - if you did a search of your name it would pop up before Bill Gates.  Seriously. ;)

[Deb_c430]

Oh geesh, I had written thanks to you and all for the info, lol I am in a fog today,  I am not sure why i even made this a two parter and didn't answer myself!  Smacks head, I should have had a v8!

But truly thanks for all YOUR help, Michaels, everyone.   I going to go on holiday, let my brain white out get some sun!

Yes, I had a iron and Ferritin, they will do another one next week and a Underlying hematologic diseases (ie, thalassemia, refractory anemia, or other myelodysplastic disorders).  

You know this was very good info Jim, for those of us on Epotien, also why some take iron and some don't.  Thats always confused me.

Deb

[Deb_c430]

LDL haptoglobulin
Iron studies ferritin Tsat
reticulocyte count

here is the other part of labs he ordered for second testing.

[mikesimon]

"When haptoglobin levels are decreased, along with an increased reticulocyte count and usually also a decreased RBC count, hemoglobin, and hematocrit, then it is likely that the patient has some degree of hemolytic anemia.

If the haptoglobin is normal and the reticulocyte count is increased, then RBC destruction may be occurring in organs such as the spleen and liver. Because the freed hemoglobin is not released into the bloodstream, the haptoglobin is not used up and so is normal.

If the haptoglobin concentrations are normal and the reticulocyte count is not increased, then it is likely that any anemia present is not due to RBC breakdown.

If haptoglobin levels are decreased without any signs of hemolytic anemia, then it is possible that the liver is not producing adequate amounts of haptoglobin.

Haptoglobin is considered an “acute-phase” protein; this means that it will be elevated in many inflammatory diseases, such as ulcerative colitis, acute rheumatic disease, heart attack, and severe infection. This will complicate the interpretation of the haptoglobin results. Haptoglobin testing is not generally used to help diagnose or monitor these conditions."

http://www.labtestsonline.org/understanding/analytes/haptoglobin/test.html

[Deb_c430]

Wow, that is scary!    I need to read this a few times to get it all straight!

So acute phase meaning what? spleen or liver failure?    This is all new to me.    Thanks Mike,  Deb

[mikesimon]

Don't worry Deb. You know you have hemolytic anemia and that's what you'll see - decreased haptoglobin and increased little itty-bitty baby red blood cells.
I ordered those same tests for myself 2 years after treatment when my hgb and rbc were borderline or a little low. I didn't have hemolytic anemia thankfully because I was not treating. My transplant team wasn't concerned but they acquiesced to the tests anyway. Your results will be fine. I am interested in the iron studies but I understand why they'd order these tests. Just dotting all the i's and crossing the t's.
Mike

[Deb_c430]

ok, I had a moment,     breathing again,

[Deb_c430]

Ok here is another question, remember when I asked you all about tear drop blood cells?

Would that relate? She is sending my lab paper work today. so I can try and scan them,

[geterdone]

“Caution”, when taking supplemental iron to boost serum iron stores in the preparation of Procrit intervention it is advised to forgo any MRI imaging scans and do not go with in 10ft of any Magnets.  

jasper