low MCH and Ferritin

[justy]

Hi, i have had persistently low ferritin and MCH for years. My ferritin was at about 5 but with two years of iron supplements it has gone up to on;ly 11. My MCH is always low. My B12 is low side of normal (240) My GP is not concerned about this as my 'iron count' is just about normal so he says i am not aenemic. I'm now using a transdermal iron spray and hope to get tested soon.

Does anyone here know much about waht MCH is and its implications - all i could find on the net said that it could mean i have 'aenemia of chronic illness' - what does that mean!?
I have been aenemic in the past, starting at age 11 and then on and off my whole life. I was tested for coeliac - the range was 1-10 and mine came back at 10 so considered normal (i presume if it was 11 they would have said i was coeliac) i have tried a gluten free diet for as long time and when i gave up on it last year oit seemed to make no difference to my health at all. Infact some pof the gluten free substitutes were definately upsetting my gut (mainly corn i think)
Thanks, Justy.

Just remembered, low haematocrit too.

 

[justy]

Is there nobody out there who is willing to chat about this with me?

 

[Cindi]

What was your MCV?

 

[rlc]

Hi justy low MCH (Mean Corpuscle Haemoglobin) can mean quite a lot of things the diagnosis pro site says it can be caused by this list of 32 illnesses http://en.diagnosispro.com/differential_diagnosis-for/mch-lab-decreased/10421-153.html so your doctor has some work to do. Unfortunately the diagnosis pro site is undergoing one of its regular updates and it wont let me add your other test results, but as soon as it is working properly I will do that for you and see if it comes up with any answers.

Your B12 levels are very much on the low side and there is a chance getting them elevated may help relieve some of your symptoms, most labs are using a reference range that is out of date, normally 130- 850 pmol/L this article http://www.sah.org.au/assets/files/PDFs/Pathology PDFs/Vitamin B12 Update_San Dr.pdf says

The lowest concentration to be considered normal is 221 pmol/L. (Herbert 1996b)

so your very close to being deficient, being anaemic from B12 is a late sign of being very deficient in B12 and your doctor should not be using this as a way to rule out vit B12 deficiency, but a lot of them are not up to date with newer research, and your ferritin levels are low so I dont quite see how they think your iron is normal??

Dr Shirwan Mirza points out that these false beliefs about B12 deficiency are written into the NICE CFS guidelines in his article Chronic fatigue syndrome NICE and CDC miss the boat, on this page http://www.bmj.com/content/335/7617/446?page=2&tab=responses

The problem with these guidelines is that they either omit major causes of
fatigue or make flagrant misguided mistakes such as the following NICE
statement: Vitamin B12 deficiency and folate levels should not be carried out
unless a full blood count and mean cell volume show a macrocytosis.

Vitamin B12 deficiency (or insufficiency) is extremely common even without
macrocytosis. Macrocytosis is a very late sign of this vitamin deficiency.
Furthermore, a concomitant iron deficiency, such as in celiac disease,
would cancel out macrocytosis and the resultant mean corpuscular volume of
the RBC would be normal.

He goes on to say . "Even if
B12 level is 221 pmpl/L (300 pg/m)l but homocysteine or methylmalonic acid are elevate,
a diagnosis of B12 insufficiency should be made and the fatigued patient
must be treated. Vitamin B12 is a very common cause of fatigue, malaise, dizziness and
vertigo in people labeled with the diagnosis of CFS.

So to me it looks like with your level of 240 you certainly fall in the at risk group of having a possible B12 deficiency missed because of out of date doctors and reference ranges. Cant promise anything but maybe getting your B12 up to the higher end of the reference range may relieve some of your symptoms, theres some articles about symptoms of B12 deficiency here, and I will get back to you when diagnosis pro starts working properly again.

http://www.essortment.com/peculiar-symptoms-even-borderline-vitamin-b12-deficiency-48485.html
http://vitamins.lovetoknow.com/Vitamin_B12_Deficiency_Symptoms

All the best

 

[taniaaust1]

Justy. I just posted about my iron issue which is like yours.. see my post at bottom of following thread second to last or third to last paragraph of my post... may explain too what is going on with yours as well.

ohh edit.. sorry it does help if I add the link so you can find my post http://forums.phoenixrising.me/showthread.php?15129-Hair-analysis-at-ARL

 

[justy]

MCV Normal.
Havent had time to read up all your posts yet -thank you so muvch for responding. I am doing daily B12 injedctions and they are helping a bit after 3 months on them (very low dose)
rlc - i was hoping you would show up withb your diagnosis tool - i cant get the hang of working that site at all!
will post back more thoughts after reading the links - ta! Justy.

 

[rlc]

Hi justy, diagnosis pro is still being updated hopefully it wont be down for too long, Ill keep an eye on it and let you know the results as soon as its working properly.

Glad to hear youre taking B12 shots. Came across this information on this site http://circustuff.com/vitamin-b12-faq/b12.html

Vitamin B12 deficiency starts to appear in cerebrospinal fluid at below 550 to 600 pg/ml or about 405 to 442 pmol/l. Deficiency on lab tests are classed as 220pg/ml or 160pmol/l which is why vitamin B12 deficiency is commonly misdiagnosed. Ask for your B12 blood test and check your results to confirm you are in the healthy range over 800pg/ml or 600pmol/l. A more accurate test to pick up even the mildest of deficiencies is a urinary methylmalonic acid test.

A study in the US found that 39% of studied group of 3000 had low B12 levels. This study at Tufts University classed B12 levels at 350pg/ml or 258 pmol/l as low level. As deficiency is found in spinal fluid at 550 600pg/ml or 405 to 442 pmol/l, B12 deficiency would be in a far higher than 39% as reported by Tufts University.

So at 240 pmol/l your about 200 pmol/l under the range where deficiency starts to appear in cerebrospinal fluid, and they recommend being over 600pmol/L as the healthy range, so your 360 pmol/L under that, so keep taking the shots until youre up to 600 pmol/l and hopefully it will get rid of a lot of your symptoms.

RE your doctor saying you dont have Anaemia so you cant be B12 deficient, this study was done in 1988 that shows you can have symptoms of B12 deficiency without having Anaemia or Macrocytosis, so unfortunately your doctor is 24 years out of date! http://www.ncbi.nlm.nih.gov/pubmed/3374544

All the best

 

[rlc]

Hi justy, diagnosis pro is working again, decreased MCH and Ferritin gives you 9 possible diagnoses see http://en.diagnosispro.com/differen...eased-ferritin-serum/10421_11876-153_153.html if you add decreased Heamatocrit you get 8 possible diagnoses see http://en.diagnosispro.com/differen...hematocrit/10421_11876_11908-153_153_153.html

Based on the assumption that all your failed tests are caused by the same disease, which is normally the case, your results show you may have,

1. A hook worm infection which I remember you did have some positive results from worming treatment, but not sure if you have had hook worm infection tested for?

2. You may have whipples disease which is a rare bacterial infection, that I doubt your doctor would ever have thought of, info on it here http://www.mayoclinic.com/health/whipples-disease/DS00757 it causes a lot of stomach problems as well as fatigue muscle pains etc, and causes malabsorbtion of vitamins and minerals which would explain the low ferritin and B12, tested for by small bowl biopsy and is treatable.

3. You may have Sprue (gluten enteropathy) fancy medical name for celiac, which also causes similar symptoms to whipples, and malabsorbtion, although you didnt improve much with not eating gluten foods, its possible that your low vitamins and minerals werent treated properly to get them up to the right levels, which is why you remained sick, it is after all the low vitamins and minerals that make you sick not the gluten. Your levels are at the very high end of normal, and you should be tested with a small bowel biopsy to make sure and they can check for whipples at the same time.

4. You cant have Celiac disease of childhood because youre not a child.

5. Although you have low ferritin from my understanding of your tests you dont have anaemia so you cant have iron deficiency anaemia.

6. Would be amazed if you have scurvy unless you havent eaten fruit or vegetables for years.

7 and 8 your tests dont show you have anaemia so you cant have anaemia from blood loss or chronic disease.

The extra disease that comes up when I just add decreased MCH and ferritin, is Ulcerative Colitis which doesnt seem to fit as well as the other three from what I know of your symptoms, but there is information on it here http://www.medicinenet.com/ulcerative_colitis/article.htm

So working on the assumption that your failed tests are all caused by the same illness, and you don't have aneamia, I would recommend printing out the diagnosis pro list and taking it to a doctor, and getting them to refer you to a gastroenterologist to check you out properly for Hook worm, Whipples and Celiac because all of them cause the type of symptoms you have and they all cause low ferritin and the other failed test results, and if youre lucky and dont have two conditions which would mess up the test results you should have a diagnosis very quickly and all of these conditions are treatable. If it is one of these remember that they all cause malabsorbtion and the vitamins and minerals will need to be brought up to the right levels before you come right completely.

Best of luck!!!!!

 

[DougM]

Hi, i have had persistently low ferritin and MCH for years. My ferritin was at about 5 but with two years of iron supplements it has gone up to on;ly 11. My MCH is always low. My B12 is low side of normal (240) My GP is not concerned about this as my 'iron count' is just about normal so he says i am not aenemic. I'm now using a transdermal iron spray and hope to get tested soon.

Does anyone here know much about waht MCH is and its implications - all i could find on the net said that it could mean i have 'aenemia of chronic illness' - what does that mean!?
I have been aenemic in the past, starting at age 11 and then on and off my whole life. I was tested for coeliac - the range was 1-10 and mine came back at 10 so considered normal (i presume if it was 11 they would have said i was coeliac) i have tried a gluten free diet for as long time and when i gave up on it last year oit seemed to make no difference to my health at all. Infact some pof the gluten free substitutes were definately upsetting my gut (mainly corn i think)
Thanks, Justy.

Just remembered, low haematocrit too.

The quick answer is that red blood cells (erythrocytes) start off as stem cells that contain a nucleus and mitochondria (plus the other organelles etc). Those stem cells undergo differentiation (the process of changing from one cell type to another). So, Multipotential haematopoietic stem cells go through a series of changes---1) stem cell--->2) Common myeloid progenitor--->3) Proerythroblast-->4) Basophillic erythroblast--->5) Polychromatic erythroblast--->6) Orthochromatic erythroblast (aka normoblast)--->7) Polychromatic erythrocyte (aka reticulocyte)--->8) full matured erythrocyte---and during these changes, the mitochondria produce the haemoglobin which goes on to adsorb oxygen from the lungs when that erythrocyte (red blood cell) is in active service. Once the maturing red blood cell reaches the Reticulocyte stage (stage 7), that cells organelles (including the mitochondria and the nucleus) are expelled from the maturing red blood cell. This expulsion of cell organelles from red blood cells helps them remain immune to oxidative stressors that would be produced in the mitochondria.

Now, here's the key point: in order for the mitochondria to produce haemoglobin, energy is required. The mitochondria produces ATP (the energy molecule) through a process known as oxidative phosphorylation. Every molecule of glucose that comes from the food you eat is turned into 38 ATP molecules, 30 of which come from oxidative phosphorylation. For ME patients, the chronic inflammation you suffer continuously---causing chronically high levels of circulating proinflammatory cytokines---causes high levels of oxidative and nitrosative stress that leads to key enzymes in the mitochondria to be totally inhibited, leading to a large reduction in the amount of ATP that comes from one molecule of glucose. So, one reason for maturing red blood cells not to produce normal levels of haemoglobin might well be because mitochondrial dysfunction means they don't have enough energy to make as much haemoglobin.

One of the main toxins produced by the mitochondria as a result of ME is called peroxynitrite (chemical symbol ONOO-). This ONOO- directly inhibits the electron transport chain (ETC) resulting in reduced production of ATP.

So, the main way you can help your developing immature red blood cells to produce more haemoglobin is to
1) Supplement on ferritin and iron so you're not in deficiency.
2) Take supplements that counteract the oxidative and nitrosative stressors (see images of the tables attached).

If red blood cells contained mitochondria (like they do in birds), it is likely that the haemoglobin would be inactivated by peroxynitrite, so ME would be fatal.