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Hematology/Anemia and Hemochromatosis

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Question
Well.

I am a 44 year old female, premenopausal, non-vegetarian.
I used to be a blood donor, but was too often rejected for low Hb.

I have several anemia risks: heavy menstrual cycles, endometrial  polyp, 4 late-1st trimester miscarriages, and birth of twins.

I had been feeling run-down, and started losing my hair. My Internist checked my ferritin= 10.7
I started taking high dose iron (glycinate and polypeptide). After 3 months my ferritin had risen to 26, and my hair stopped shedding. My internist recommended I stop iron supplements because I was "normal." I refused and only cut back my dosage. 3 months later my ferritin is 20, and my hair is shedding again.

To combat the bleeding, I had a polypectomy done (no change), and had a Mirena IUD inserted (at 6 months I finally see a bleeding reduction). Still fatigued, will ask for a ferritin test at next appointment.

Now- I purchased the 23andme DNA kit (for the ancestry) but had it checked, only to find I am homozygous for the Hereditary Hemochromatosis C282Y SNP!

So to actually get to my question... I am still seriously affected by fatigue, and I've read Dermatology journals that suggest a ferrtin level of 70 is needed for substantial hair re-growth.

Is it reasonable to keep supplementing iron to get to a ferritin level 70-100? Then stop, and return to blood donation to keep the HH at bay?

Should I be seeing a specialist proactively?


Sorry this is so long- J

Answer
Jennifer,
If I am not wrong 23andme got banned in USA because of not meeting FDA standards and discrepancies in reports. They are not considered as a medical service company. So I dont know how much we can trust their results. Because looking at your low ferritin levels, I dont think you have hemochromatosis. You could be, I am not denying it but transferrin saturation is needs to be tested to confirm it. Next time ask your internist to get transferrin iron saturation and LFT tested.

Acccording to you after inserting IUD 6 months back, bleeding has reduced. Still your ferritin is low. Right? This is not typical of homozygous hemochromatosis. Homozygous patients accumulate iron so fast some need blood letting every week, on an average once in 2-4 weeks. Considering you are taking iron supplements, your levels should have been somewhere around 100 if you were homozygous for hemochromatosis. These two results are not adding up. So my suggestion is if you believe in 23andme results, better ask your internist for transferrin iron saturation and LFT. Or visit a nearby heamatologist. He will conduct all required tests for hemochromatosis.


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Hematology

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Dr.Shrinidhi Kulkarni

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I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!

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