1

votes

Mysterious Anemia - not Iron, B12 or Folate defficiency

Answered on January 01, 2015
Created August 16, 2011 at 1:01 PM

I'm a man and I have 12.3 hemoglobin. My blood tests say Iron, B12 and Folate (B9) are alright.

My Hematocrits are low, and Ferritin high.

What gives?

D7b01bbfd0b91a12c4aea43fb20adf15

(574)

on October 09, 2011
at 12:25 AM

Are MCV and MCH low? What about RBC count?

072fd69647b0e765bb4b11532569f16d

(3717)

on August 17, 2011
at 10:25 PM

CaveRat, my gastro doc/friend has mentioned we need to watch for signs of mylofibrosis (his father in law had it so maybe a bias). I haven't read much about EPO or discussed with the doc, but I do have some funky kidney readings, which at times indicate reduced function. Thanks for the info.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:53 PM

My multi-vitamin has no iron btw.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:53 PM

Thanks for the warning CaveRat.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on August 17, 2011
at 07:34 PM

Tom, your overall description sounds a LOT like me - including the colonoscopy that showed nothing. However I've been plagued with low 'energy' - motivation/focus/clarity/whatever - for most of my life. I've just rolled with it since there never was any resolution, but now I have a doctor expressing interest in pursuing it, thus the EPO test and perhaps a marrow if that does't show anything. Jonas: With high ferritin you probably shouldn't take ANY iron (in case you are). In excess - even with low RBC - it can be bad for you.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on August 17, 2011
at 07:19 PM

I've taken Vit C in various forms, and have always been a big fruit eater (pre paleo - adding it in lately though). I've shown low RBC for at least 10 years and probably longer. Might be related to thyroid I suspect, but not sure what to do about it if so

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 05:34 PM

Good common sense, thanks.

072fd69647b0e765bb4b11532569f16d

(3717)

on August 17, 2011
at 02:25 PM

I wouldn't get real wound up about the difference between 12.9 and 12.3, especially with just two tests. Both are on the low end. I'm no doctor but would encourage you to stick with your Paleo plan and get any help you need with the OCD and anorexia. Considering you have those in your background, I would advise against IF. Eat regular meals even if you aren't hungry. Get some good exercise, but don't overdo it. Get your bloodwork checked every few months, and if you don't see improvement, talk to your doctor about the next steps.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 01:31 PM

Jan, Potassium is ok according to blood tests.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 01:30 PM

No, I just started eating some cabbage recently.

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:30 AM

Perhaps you are short on potassium then? Maybe Zinc too.

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:28 AM

Btw, do you eat alot of cabbage or drink green tea?

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:27 AM

I only ate pinhead oatmeal (organic and gluten free) and real sourdough rye bread. Otherwise my old diet was nearly paleo. I ate more fruits also.

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:24 AM

This one: http://www.iherb.com/Now-Foods-Vitamin-C-Crystals-8-oz-227-g/413?at=0

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:11 AM

By the way, interesting bit about the more water/hydration and the perceived decrease in hematocrit levels: at the time of that blood test I was indeed drinking LOTS of WATER (to up my pulse rate which was very low).

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:08 AM

Grenadine, if I eat when I'm hungry I end up eating twice a day only... and then I usually feel crap. I hope that now that I've gone to 3 squares a day that I may feel better... I hope (I forced myself breakfast).

559aa134ff5e6c8bcd608ba8dc505628

(3631)

on August 17, 2011
at 05:23 AM

Good luck to you. Are you seeing a pro for the anorexia?

559aa134ff5e6c8bcd608ba8dc505628

(3631)

on August 17, 2011
at 05:22 AM

eat when you are hungry. this obsessive meal-scheduling has got to stop. RE your comment to Tom R -- hematocrit value is the % of red blood cells in a given sample; hydration is a factor. If you are truly making an effort to eat more and regain health, it is likely that you are now better hydrated, which can cause a perceived decrease in hematocrit levels. i.e. you may not actually have fewer red blood cells, just more water. You need to keep eating *lots of food* to make more red blood cells. no wonder you feel tired! you need those cells to carry oxygen!

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:52 PM

This just makes me all the more desperate. My life pre paleo was 5 meals a day with lots of oatmeal, cereal sugary power bars, milk, bread, rice and other grain-FEAST foods. I was healthy. Now I turned to SHIT.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:48 PM

I also take Vit. C: Now Foods TruC or Madre Labs Vit. C with Camu Camu: all good sources. Still no go. On May my levels were 12.9, and I was out of the hospital for a month or two (I was in the hospital due to Paleo+IF+OCD+anorexia). On August I'm 12.3. Getting worse it seems... I've gained some weight back, tried different meals, more meals, less meals, I don't know what the hell to do.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:46 PM

Tell me about it... I'm dragging my ass for most of the day.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:42 PM

Yes... I've discovered Primal/Paleo, then IF and turned OCD and developed anorexia, losing massive amounts of weight, depression, anxiety and lack of sleep. It's very likely related, I just don't know how to heal my Anemia if I don't know what's wrong with me.

Medium avatar

(39821)

on August 16, 2011
at 06:24 PM

What form do you use?

44348571d9bc70c02ac2975cc500f154

(5853)

on August 16, 2011
at 04:17 PM

I am taking 4 grams a day, plus whatever comes with real food. So it should be plenty.

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10 Answers

2
072fd69647b0e765bb4b11532569f16d

(3717)

on August 16, 2011
at 05:58 PM

I've posted several times on here regarding my unexplained anemia (35 year old male). My hemoglobin is also about 12.3. At times, my iron and ferritan levels have been low but are currently fine. B12 is fine. My WBC and RBC counts are slightly low (3.4 and 3.65) but improving. Hematocrit is low (36.6). My general practitioner first referred me to a gastroenterologist thinking a malabsorption issue might be in play. I've had a colonoscopy, which didn't turn up anything, and the gastro referred me to the hematologist who ran his tests and also found nothing. The gastro (a family friend) suspects wants to send me back to the hematologist to have my bone marrow examined. I haven't lept at that opportunity yet. At this point, I feel great and don't find the doctor visits to be all that productive. As such, I have agreed with the gastro to get my bloodwork done twice a year and see where it goes. In the meantime, I'm working in a little extra Vit C per Travis's posts.

Best wishes.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:53 PM

My multi-vitamin has no iron btw.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 05:34 PM

Good common sense, thanks.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:48 PM

I also take Vit. C: Now Foods TruC or Madre Labs Vit. C with Camu Camu: all good sources. Still no go. On May my levels were 12.9, and I was out of the hospital for a month or two (I was in the hospital due to Paleo+IF+OCD+anorexia). On August I'm 12.3. Getting worse it seems... I've gained some weight back, tried different meals, more meals, less meals, I don't know what the hell to do.

072fd69647b0e765bb4b11532569f16d

(3717)

on August 17, 2011
at 02:25 PM

I wouldn't get real wound up about the difference between 12.9 and 12.3, especially with just two tests. Both are on the low end. I'm no doctor but would encourage you to stick with your Paleo plan and get any help you need with the OCD and anorexia. Considering you have those in your background, I would advise against IF. Eat regular meals even if you aren't hungry. Get some good exercise, but don't overdo it. Get your bloodwork checked every few months, and if you don't see improvement, talk to your doctor about the next steps.

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on August 17, 2011
at 07:34 PM

Tom, your overall description sounds a LOT like me - including the colonoscopy that showed nothing. However I've been plagued with low 'energy' - motivation/focus/clarity/whatever - for most of my life. I've just rolled with it since there never was any resolution, but now I have a doctor expressing interest in pursuing it, thus the EPO test and perhaps a marrow if that does't show anything. Jonas: With high ferritin you probably shouldn't take ANY iron (in case you are). In excess - even with low RBC - it can be bad for you.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:53 PM

Thanks for the warning CaveRat.

072fd69647b0e765bb4b11532569f16d

(3717)

on August 17, 2011
at 10:25 PM

CaveRat, my gastro doc/friend has mentioned we need to watch for signs of mylofibrosis (his father in law had it so maybe a bias). I haven't read much about EPO or discussed with the doc, but I do have some funky kidney readings, which at times indicate reduced function. Thanks for the info.

2
Medium avatar

on August 16, 2011
at 04:03 PM

How much vitamin C are you guys taking? If this is occurring post-paleo and you're doing VLC or something, it could definitely be due to low vitamin C.

44348571d9bc70c02ac2975cc500f154

(5853)

on August 16, 2011
at 04:17 PM

I am taking 4 grams a day, plus whatever comes with real food. So it should be plenty.

Medium avatar

(39821)

on August 16, 2011
at 06:24 PM

What form do you use?

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:24 AM

This one: http://www.iherb.com/Now-Foods-Vitamin-C-Crystals-8-oz-227-g/413?at=0

Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on August 17, 2011
at 07:19 PM

I've taken Vit C in various forms, and have always been a big fruit eater (pre paleo - adding it in lately though). I've shown low RBC for at least 10 years and probably longer. Might be related to thyroid I suspect, but not sure what to do about it if so

2
Fe29f6658ce67c1ecc4a22e960be7498

(2997)

on August 16, 2011
at 02:19 PM

I have the same but with normal ferritin. My MD has had me run some interesting tests (e.g., hemoglobin electrophoresis) which show normal. My next test will be for EPO levels - the hormone made by the kidneys that tell the marrow to make more red blood cells (some bicyclists inject themselves with this - illegally - to get a racing edge). I'm also being referred to a hematologist.

Another way to generate extra RBCs is to go to higher altitude - do you live lower down like I do? Athletes do this artificially by working out in oxygen-reduced environments (hypoxia). I'm looking into ways to do this cheaply, by bag breathing or swimming under water... Another technique is 'blood volume depletion' - they bleed you to trigger the marrow to make more blood. There may be nutritional approaches (def NOT iron supplementation if your ferrirtin is normal or high), perhaps Calcium/Magnesium or something else.

Let me know if you find anything useful! I'm not able to donate blood because my RBC is too low, and there are obvious other health/energy issues with anemia - which is rather rare in a guy of course.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:46 PM

Tell me about it... I'm dragging my ass for most of the day.

1
121a16aded2bed8dca492d3c9662ef4c

on March 16, 2013
at 12:11 AM

I realize this post is really old, and you haven't been on in over a year, but maybe someone else will have a similar problem and stumble upon this question, so I'll try anyway.

You have a strange, mild anemia that is unexplained by iron, folate or B12 deficiency.

But your parathormone (PTH) is elevated. Have you had your vitamin D status checked? Elevated PTH hints at low vitamin D levels, which are associated with stubborn anemia. You might have kidney problems: if your kidneys aren't producing EPO for any reason, then you'll end up anemic even if your diet is nutritionally adequate.

So:

  • check your vitamin D levels,
  • have your kidneys checked,
  • have your EPO levels checked,
  • eat more! Some of your symptoms are characteristic of starvation (Right after writing this, I read the bit where you mention anorexia. There's probably most of your answer. Kidney failure is a late-stage sequela of anorexia.)

Finally, the ferritin level can be very misleading. It's an acute phase reactant, so it elevates in response to inflammation, even in iron-deficient patients. You need to look for other possible causes of the elevated ferritin. What's the TIBC or transferrin saturation?

0
0405f2f353238f8a12f0992fb121701b

(0)

on January 01, 2015
at 10:22 PM

Have you ever been tested for G6PD deficency or other kind of hemolytic anemia?

0
711111ffc3910030a548fc3c3d8b4974

on February 18, 2014
at 11:57 PM

Seeing as this is a really old post I hope you've already figured out/corrected whatever was causing the anemia, but I still wanted to post this in case anyone else stumbles across it like I did. I've been struggling with a somewhat similar issue for about a year now... I have mildly low RBC, HGB & HCT, low/normal iron with normal/high ferritin (amongst other physical symptoms, including fatigue, etc.). B12 & B9 tests are fine. Currently eat a fairly strict paleo diet ala Perfect Health Diet.

You may want to check for some sort of viral infection... Doctors have run tons of tests on me and most everything else is coming back normal except for a primary Epstein Barr Virus infection (from the reading I've done, almost everyone gets it as a child/teenager, but when you do get it as an adult, the severity/length of time for recovery can be much greater). I'm still pushing for additional tests to ensure there's nothing else going on, and I have gotten some of them, but so far nothing is showing up other than the virus.

0
687bcdeaf37909fd0a6c3dbcc244f1de

on February 18, 2014
at 06:21 PM

Wow! Well I tried to give plasma yesterday, after successes pre paleo, but was gluten and dairy free. Post paleo, my hematocrit is too low, 36 of 38 needed. I had chicken at lunch, lots of baby bell peppers that week, strawberries, etc., so vitamin c should've been adequate. I haven'tbeen taking my vitamin d supplement lately though, and live in Midwest.

0
D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:49 PM

(This is Jonas the OP)

By the way my carbs are around 200g per day, give or take.

What's a good meal frequency for anemia? Well, my strange anemia I mean? 3 squares a day? 3 + 1 snack?

EDIT Just got my blood tests from one month ago.

low erythrocytes - 4.0

low Free T3 - 1.1

high parathormone

low aldosterone

559aa134ff5e6c8bcd608ba8dc505628

(3631)

on August 17, 2011
at 05:23 AM

Good luck to you. Are you seeing a pro for the anorexia?

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:08 AM

Grenadine, if I eat when I'm hungry I end up eating twice a day only... and then I usually feel crap. I hope that now that I've gone to 3 squares a day that I may feel better... I hope (I forced myself breakfast).

559aa134ff5e6c8bcd608ba8dc505628

(3631)

on August 17, 2011
at 05:22 AM

eat when you are hungry. this obsessive meal-scheduling has got to stop. RE your comment to Tom R -- hematocrit value is the % of red blood cells in a given sample; hydration is a factor. If you are truly making an effort to eat more and regain health, it is likely that you are now better hydrated, which can cause a perceived decrease in hematocrit levels. i.e. you may not actually have fewer red blood cells, just more water. You need to keep eating *lots of food* to make more red blood cells. no wonder you feel tired! you need those cells to carry oxygen!

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:30 AM

Perhaps you are short on potassium then? Maybe Zinc too.

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 08:11 AM

By the way, interesting bit about the more water/hydration and the perceived decrease in hematocrit levels: at the time of that blood test I was indeed drinking LOTS of WATER (to up my pulse rate which was very low).

D89511137c1849427593b3ef172578cb

(395)

on August 17, 2011
at 01:31 PM

Jan, Potassium is ok according to blood tests.

0
601b317ef11d7d8382e2da09d5152de1

on August 16, 2011
at 03:26 PM

Are you on a calorie restricted or neutral diet?

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:42 PM

Yes... I've discovered Primal/Paleo, then IF and turned OCD and developed anorexia, losing massive amounts of weight, depression, anxiety and lack of sleep. It's very likely related, I just don't know how to heal my Anemia if I don't know what's wrong with me.

0
44348571d9bc70c02ac2975cc500f154

(5853)

on August 16, 2011
at 02:23 PM

i have the very same problem, pre-paleo my bloodwork was awsome. Now its not. Propably some deficiency that i havent still figured out. Erythocyte values are dropping as well

44348571d9bc70c02ac2975cc500f154

(5853)

on August 17, 2011
at 08:27 AM

I only ate pinhead oatmeal (organic and gluten free) and real sourdough rye bread. Otherwise my old diet was nearly paleo. I ate more fruits also.

D89511137c1849427593b3ef172578cb

(395)

on August 16, 2011
at 08:52 PM

This just makes me all the more desperate. My life pre paleo was 5 meals a day with lots of oatmeal, cereal sugary power bars, milk, bread, rice and other grain-FEAST foods. I was healthy. Now I turned to SHIT.

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