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Anemia of chronic disease: which tests?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by aquariusgirl, Jun 24, 2012.

  1. aquariusgirl

    aquariusgirl Senior Member

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    hi, i suspect i have anemia of chronic disease. I would like to run some blood tests to confirm this. I was thinking ferritin, ZPP, TIBC. Not sure if I need serum iron. Any thoughts? Thanks.
     
  2. Ema

    Ema Senior Member

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    Serum iron, TIBC/UIBC, %sat, and ferritin should be sufficient.
     
  3. Emootje

    Emootje Senior Member

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    I think that ZPP is the best test to diagnose anemia of chronic disease because it is a end point control of the whole iron metabolism.

    "ZPP is not a simple parameter of iron deficiency but rather
    a screening parameter of iron deficient erythropoiesis, surveying
    all steps of the iron metabolism from iron uptake to
    its utilization. Thus, the ZPP determination can serve as a
    kind of “end point control” of the whole iron metabolism,
    which detects real iron deficiency as well as derangements of
    iron metabolism in chronic inflammatory and neoplastic
    disease in sideroblastic disorders, eg, myelodyplasias,
    or after lead poisoning"
    http://bloodjournal.hematologylibrary.org/content/81/5/1200.full.pdf
     
    merylg likes this.
  4. Emootje

    Emootje Senior Member

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    Hepcidin could also be helpful.
     
  5. Ema

    Ema Senior Member

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    I agree that the ZPP test can be interesting but the serum iron, TIBC/UIBC and ferritin are more key in my opinion. I had a mildly high ZPP test.

    A full iron panel is only about $25 whereas the ZPP test is a lot more expensive and doesn't provide any additional information from a practical (do i need iron and how much?) standpoint.

    Further the ZPP test does not provide any information about the body's ability to safely supplement and store iron. So even if the ZPP was high, one would still need the TIBC/UIBC to know how much iron to take without getting unpleasant symptoms of free iron.
     
  6. Emootje

    Emootje Senior Member

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    I think it's best to test them all (iron, transferritin, ferritin and ZPP).
    In the Netherlands the ZPP test is about 17 euro, so it's affordable.
    My ZPP test was also mildly high...
     
  7. aquariusgirl

    aquariusgirl Senior Member

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    Ok, thanks.
     
  8. out2lunch

    out2lunch Senior Member

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    I'm going to resurrect this thread (insert zombie emoji here) because I have a serious need for the collective wisdom of PR members who understand iron metabolism better than I do.

    Over the past year, functional med doc and I have run the following tests to deal with my iron deficiency:

    CBC/Chem Panels
    Anemia Panels consisting of serum iron, TIBC/UIBC, saturation %, transferrin, ferritin, folate, B12
    FEP/ZPP
    Lead
    Copper/Zinc

    Everything looked good except for the FEP/ZPP about 8 months ago, which was modestly elevated. But increasing iron supplementation has brought that down to the normal range cutoff.

    We've also done Genova stool testing that looked good except for n-butyrate that was a bit wimpy, and Cyrex arrays for gut inflammation, celiac, cross reactivity, etc, which were all completely negative. I've also had extensive interleukin testing which was also normal.

    In a nutshell, my serum iron and ferritin have been nearly impossible to keep out of the basement, even with daily supplementation and meat consumption. No evidence of blood loss anywhere; just iron deficiency. And the typical iron deficiency symptoms such as burning tongue, cracked mouth corners, and spoon nails have also plagued me, especially the burning tongue. I wouldn't wish that one on my worst enemy.

    The one thing we know is that I can keep my serum iron levels up and increase my ferritin in a matter of weeks instead of months by injecting low dose heparin every day. (That's how the FEP/ZPP was reduced.) We've done anemia panels on and off heparin, and it's definitely the heparin that's increasing serum iron and ferritin.

    Heparin is an inhibitor of hepcidin, which is the gut's gatekeeper for iron absorption. Obviously my hepcidin levels are being elevated by some inflammatory disease state which the heparin is overriding. Problem is, what is the inflammation and where is it residing if it's not residing in my gut?

    Any thoughts? Thanks! :)
     
    Emootje likes this.
  9. out2lunch

    out2lunch Senior Member

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    Do you have any idea which labs test for hepcidin in the US? My doc has been unable to locate any. Thanks!
     
  10. Emootje

    Emootje Senior Member

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  11. out2lunch

    out2lunch Senior Member

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    450 euros? OUCH! That's over 500 US dollars. :eek:

    But pretty cool about the drug trial. I've never heard of lexaptepid.

    Thanks for the info!
     
    Emootje likes this.
  12. out2lunch

    out2lunch Senior Member

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    UPDATE: IntrinsicDX now offers a hepcidin test to US healthcare providers: http://intrinsicdx.com.

    I don't know how much the test costs yet. It requires a blood draw and 5 days turnaround time.

    Hopefully, it won't be as expensive as the test mentioned above in the Netherlands. :nervous:
     
    Emootje likes this.

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