About Paul Charest Expertise Any questions that have to do with hematology. Explaining laboratory tests including :coagulation (PT/aPTT), CBC, differential, ESR, and flow cytometry (leukemia/lymphoma)also including the theory behind them. Hemoglobinopathies, leukemia, lymphoma, hemostasis, hematopoiesis, and cellular morphology are a few of the topics that I teach and practice.
I also have experience with immunohematology, otherwise known as blood banking. Feel free to ask about blood types, blood groups, the type and crossmatch, transfusions, antibody identification, DAT, elutions as well as absorptions
I have also worked in a parasitology lab, as well as taught the subject as well. So feel free to ask about helminths (cestodes, trematodes, and nematodes), protozoan parasites, sporozoan etc.
Lastly, I teach a course in clinical mycology where we grow and identify yeasts and moulds.
Experience I have worked in a hematology lab, flow-cytometry lab, blood bank, and microbiology lab. I am also an instructor at Northeastern University part-time
Expert: Paul Charest Date: 5/14/2008 Subject: iron supplement and serum iron level
Question QUESTION: Hi, I took a multi-vitamin containing 18 mg of iron (100% daily value) about 20 - 24 hours before a CBC test that included a test for my iron level. My iron level came back as 192.
How long does it take for the iron supplement to metabolize? Could this make my iron test higher than it normally would? Should I avoid all supplements for a number of days prior to blood tests?
I stopped taking the multi-vitamin. A week later, I went to donate blood, and was told that my iron level was barely within the acceptable range. I have not given blood in years, but thought it would help lower my high iron. I decide not to give blood that day, as my iron had dropped. I am unsure how often I should take my multi-vitamin, and would like to know how much that supplement affected my iron blood level.
Thank You,
Linda
ANSWER: Hello Linda,It is normal to have serum iron fluctuations, this occurs naturally depending on what time it is. Diet and supplements can cause an obvious variability in serum iron. However, the serum iron test itself isn't very useful, it is most often associated with other tests such as ferritin, total iron binding capacity, percent transferrin saturation as well as others. Diagnosis is based on the above laboratory tests as well as a CBC with differential. Also, they do not test for iron (directly) when you go to donate blood. Instead they use hemoglobin, they usually stick your finger and collect a drop into a small glass cuvette that they put into a tiny spectrophotometer, and depending on the amount and wavelength of light absorbed by the hemoglobin in your blood, will give you an approximation of your hemoglobin. If your hemoglobin is low (you are probably anemic) they won't let you donate. Hemoglobin is related to iron because there are four atoms of iron in each hemoglobin molecule. And one of the most common reasons for anemia is due to an iron deficiency.Is there any reason for you to need iron supplements, do you have a diet that lacks iron? Have you been diagnosed with an iron-seficiency syndrome before? Taking an iron supplement before a blood test may cause serum iron to increase. However, some compounds such as ferritin are produced in the liver and take time to metabolize. Were there any other tests that were ordered?You shouldn't have to donate blood to lower your iron levels, or take supplements to increase your iron levels--unless indicated by your physician. There are biofeedback loops that regulate how much iron is absorbed by the duodenum, which is dependent on the need for it. I hope this helps, but if not try to find out if there are any other iron studies, which were performed--Ferritin. What is your iron status? Were you taking supplements due to a deficiency? Why are you trying to lower your serum iron levels with blood donations? Are you anemic and experiencing symptoms? What did your physician tell you?
Paul
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QUESTION: It is comforting to know that the multi-vitamin I consumed 20 hours before the blood draw probably made the iron in my CBC high. All the multi-vitamins at CVS and Wal-mart have 18 mg of iron. My diet does not lack iron. I was just taking the multi-vitamin to make sure I got all the vitamins I needed. I am aware that certain vitamins are fat-soluable and should not be taken over the recommended amount. But, I was not aware of the problems that the iron could cause. I usually read that women need iron, since they menstrate. And iron is in other popular pills, like "Women's One-A-Day". I am not anemic. They would have taken my blood. The person checking my hemoglobin only commented that I was at the low end of where they consider acceptable. Maybe because I stopped taking the multi-vitamin for a week (and still do not take it) and also stopped eating beef, and instead ate rice/beans, or chicken. I was trying to lower my iron since it was read as high from my CBC. Maybe I should take the multi-vitamin once a month on my heaviest bleeding day, as oppose to taking the pill every day?? I have never been diagnosed with an iron-seficiency syndrome before. Since my iron was high in the CBC, iron/tibc was ordered in 2 -3 months, after not taking any more iron (in the multi-vitamin). Now, I've read that for that test, one should not take any iron or vitamin c for ....one place said 24 hours, and another place said 36 hours. This test will cost me much more money, so I'll probably just wait until January and have another CBC, with out the multi-vitamin or vitamin C for 36 hours. Although 192 was high iron, it did not seem severe. I have no other symptoms.
When you wrote, " There are biofeedback loops that regulate how much iron is absorbed by the duodenum, which is dependent on the need for it. " it made me think that I am a very active and hard working person, but the day before my physical, I took it easy. May this also be a reason for the high iron level? My body had iron stored in preparation for hiking, scuba diving, mowing, landscaping, shoveling stone?
What is your iron status? 192
Were you taking supplements due to a deficiency? no
Why are you trying to lower your serum iron levels with blood donations? because my CBC showed my iron level was 192, which is higher than normal for a 42 year old female.
Are you anemic and experiencing symptoms? NO.
What did your physician tell you? he said I should stop taking the multi-vitamin - if you ask me, they should have told me this when I made the appointment and they told me to fast for 12 hours - then in 2 -3 months to get an iron / TIBC test done (which will cost me a ton of money). When I said I went to donate blood, the receptionist said the doctor said to not bother with the iron / TIBC test, since donating blood is the cure for high iron. When I said that I didn't actually go through with the donation because my hemoglobin was barely high enough after my iron level being higher than normal....well, then he wouldn't talk to me unless I made an appoint to consult with him and charge me a lot of money. So, Since I don't have a lot of money and my iron level was probably high from the iron in my multi-vitamin, I'll just get the CBC done aging with my physical in January.
What do you think?
Answer Hello again Linda,It sounds like your in pretty good shape--I just got back from shoveling a hole in my backyard for a waterfall/fish pond and I'm exhausted. You take vitamins, get plenty of excercise and you even scuba-dive. The minimum hemoglobin to donate blood is 12.5 g/dL and the normal reference range varies from hospital to hospital, but it ranges aproximately from 11.5-16g/dL. This means that some donors with normal hemoglobin values still can't donate blood. I also wouldn't lose any sleep over your iron levels, as long as you maintain a good diet you shouldn't even need to take iron supplements. As I mentioned before, serum iron results can vary based on the time of day and our ingestion of foods/supplements. 192 is only a number, and reference ranges are man-made and should be viewed as guidelines. Your baseline may just be higher than the reference range, which doesn't make you abnormal. Lastly, excercise for the most part (there are always exceptions) shouldn't increase uptake of iron. Loss of iron as with blood loss will result in increased uptake. Our body loses about 1 mg of iron each day, which needs to be replenished---so our body absorbs about 1mg to offset the loss. There are also pathologic causes for increased uptake of iron, such as hemochromatosis. So if you have a good diet, don't waste your money on supplements if you don't need them---because you will just poop them out. Food is expensive enough nowadays.
