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Crohn's Disease Forum » General IBD Discussion » Crohn's Polls » Have you been evaluated for Anemia of Chronic Disease?


View Poll Results: Have you been evaluated for Anemia of Chronic Disease?
I have been evaluated and I do have Anemia of Chronic Disease 12 37.50%
I have been evaluated and I DO NOT have Anemia of Chronic Disease 5 15.63%
I have not been evaluated. 15 46.88%
Voters: 32. You may not vote on this poll

 
02-12-2012, 08:28 PM   #1
David
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Have you been evaluated for Anemia of Chronic Disease?

I'm curious how many of you have been evaluated for Anemia of Chronic Disease (also known as Anemia of Inflammatory Response)? If you do have it, how has this affected your treatment regimen?

Thanks
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02-12-2012, 08:56 PM   #2
Emily
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hmm. I'm not really sure, I know I have Iron deficiency anemia and pernicious anemia, for which I take biweekly B-12 injections and am supposed to have Iron infusions (haven't had any in a while). Is this different than Anemia of Chronic Disease?
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02-12-2012, 09:14 PM   #3
David
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Anemia of Chronic Disease (ACD) is a form of anemia where you actually have plenty of iron in your cells as they're storing it as ferritin. However, you have symptoms of iron deficiency anemia because your cells aren't releasing the iron as they are keeping it away from pathogens that need it to proliferate and be jerks. From what I'm reading, it's common in people with Crohn's Disease. The thing is, the treatment for ACD is to cure the underlying condition. LOL? So I'm curious what physicians are doing if someone with Crohn's Disease has ACD.

Hmm, maybe I should have posted this as, "Are you anemic and have you had your ferritin levels checked?"
02-12-2012, 09:50 PM   #4
Catherine
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My daughter has hemoglobin level of 90. Her ferritin levels have raisen but the other iron level have gone down. Her levels looked like thalmassia for a long time which we are currently trying to out rule. She is still taking iron and the specialist believe it won't be needed once the Crohn's is under control only started treatment for the underlining condition 11 days ago.
02-12-2012, 10:13 PM   #5
David
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My daughter has hemoglobin level of 90.
90 g/dL or 90 g/L?
02-12-2012, 10:26 PM   #6
Catherine
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Not sure but the specialist told me 140-150 is normal.

Below 90 is the level where Sarah's specialist would consider blood transfusion. Was surprised that Sarah had been able to swim 8 times week at these levels until 3 months ago when the weight loss (12kg) and the stomach issues become severe.
02-12-2012, 10:32 PM   #7
David
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That would be g/L then. Here is the states, for children, around 111 to 160 g/L is considered normal.

If her ferritin is elevated, other iron levels have dropped despite supplementation and has moderately low hemoglobin, that potentially points to Anemia of Chronic Disease. Has her TIBC (Total Iron Binding Capacity) been tested?
02-12-2012, 10:44 PM   #8
LittleChloe
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I've never heard of this and it's very interesting to me. It seems the body is trying to protect itself by holding onto the iron? How did you come across this? I'm going to comb through Chloe's bloodwork and see what I can find.
02-12-2012, 10:49 PM   #9
David
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It seems the body is trying to protect itself by holding onto the iron?
Correct.

How did you come across this? I'm going to comb through Chloe's bloodwork and see what I can find.
I comb the internet and books for everything potentially IBD related and then try to understand it (some of this stuff melts my brain)

From what I understand, it's also possible to have iron deficiency anemia AND anemia of chronic disease at the same time which can be quite severe. I'm still a little unclear on that and have sent some emails to see if I can learn more.
02-12-2012, 11:30 PM   #10
Emily
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Okay David, so being that I have a most awesome health plan that lets me see test results online, I went to look up my most recent Iron results.
Iron(Fe): 13 ug/dL (Normal: 28 - 170)
Total Iron Binding Cap(TIBC): 525 ug/dL (Normal: 250 - 420)
% Iron (Fe) Saturation: 2% (Normal: 25 - 50%)
So I have low Iron and low Iron Saturation but high Iron binding. Is this was you are talking about? That's so interesting. I didn't even know I had high iron binding!
02-12-2012, 11:34 PM   #11
LittleChloe
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Wow, thank you so much for all you work. It's because of your prodding that I've had chloe's b12 levels and vit d levels done and we now supplement appropriately. However we've not been able to get higher than a 10.6 hemoglobin and she is low in iron. We don't want, and have not had, any blood transfusions so keeping those numbers good is very important to us. This gives me another little avenue to research. I've got to say that I have gotten more from your threads ( and others) on this forum than I ever got from our GI or any other medical professional. THANK YOU!
02-12-2012, 11:36 PM   #12
David
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Okay David, so being that I have a most awesome health plan that lets me see test results online
Wow, that's super cool! Your results point more to iron deficiency anemia since you have elevated TIBC. If it was low TIBC, that would point more to ACD.

Iron saturation is simply serum iron (your 13) divided by TIBC x 100 and that is your percentage.
02-12-2012, 11:37 PM   #13
Catherine
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Haemoglobin 93 L
Hct 0.30 L
RBC 4.1
MCV 72 L
MCH 23 L
MCHC 317
RDW 16.4
Platelets 312
White Cells 3.9 L
Neutrophils 2.6
Lymphocytes 0.7 L
Monocytes 0.4
Eosinopils 0.1
Basophils 0.0

S Iron 3 L
S Trf 1.8 L
S TRF Sat 7 L
S Ferritin 80

These are Sarah result from December. S Ferritin is also marker for inflammation.
02-12-2012, 11:40 PM   #14
Emily
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Ohhh gotcha. So I just have plain old Iron anemia like I thought. Very interesting though, I love that you get me and everyone here to pay attention to these things!
02-12-2012, 11:41 PM   #15
Catherine
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We also get interesting note as follows on her results:-

Haemoglobin Electrophoresis 15/12/2011

B Hemoglobin A2 2.8 (1.8-3.5)
B Haemoglobin F <1.0 (<1)

Comments
Results are suspicious for alpha thalassaemia trait. Testing of the partner for thalassaemia prior to pregnancy is suggested to determine whether genetic counselling and/or prenatal diagnosis are required. DNA analysis is recommended to investigate for alpha thalassaemia. This specimen has been sent to Southern Health Clinical Genetics Laboratory for further evaluation. Please refer to their report to follow.

S IRON 2L umol/L (5-30)
S TRF 1.9L g/L (2.0-3.6)
S TRF. SAT 4L (10-45)
S FERRITIN 162 NG/mL (30-200)
02-13-2012, 12:01 AM   #16
David
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S Iron 3 L
S Trf 1.8 L
S TRF Sat 7 L
S Ferritin 80
I can't find a converter to numbers I know for these, sorry.
thalassaemia trait.
I don't know anything about this but it doesn't sound too good. I hope she doesn't have it!
02-13-2012, 12:27 AM   #17
Catherine
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Hi David, I am also member a thalassaemia forum, they tell these results best fit amenia of chronic disease.

Just need to rule out thalassaemia.

Have you read about iron overload which can occur with IBD and thalassaemia.

Catherine
02-13-2012, 03:11 AM   #18
Rebecca85
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I have been tested a few times.

First in hospital, my haemoglobin was slightly low (around 10.5-11 I believe). They then checked my ferritin to see if I was a candidate for iron, and decided that no, I wasn't. So they told me 'sometimes this happens when people are ill, we'll treat the problem and see how you are in a few weeks'. They discharged me with pred and followed up with a blood test a few weeks later- haemoglobin had sneaked back into normal range (11.5 which isn't great but that's the cut off my hospital uses for young females).

6 months later my GP checked for anaemia, and found that my haemoglobin had dropped again, but this time my ferritin was low too (12), so gave me iron tablets. This soon sorted me out, and my haemoglobin has been in the 12s ever since.

So was my original anaemia ACD and not linked to my later iron deficiency anaemia? Or is it more likely that the ferritin test while I was ill gave a false high?
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02-13-2012, 03:49 PM   #19
Mayflower537
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Or is it more likely that the ferritin test while I was ill gave a false high?
I have definitely read that inflammation can cause inflated ferritin results.
02-13-2012, 04:36 PM   #20
Catherine
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With females it is important to have iron levels test at the right time in the cycle. Iron level should be highest at the end of cycle.

From what I have read people with Crohn's go between ACD and iron deficiency anaemia. I know that it is important to only be taking iron supplements when the iron studies show iron deficiency. Otherwise iron can build up in the body's organs.

http://www.australianprescriber.com/magazine/20/3/74/6/
02-28-2012, 07:56 AM   #21
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I was initially diagnosed as having anemia of chronic disease. My problem was never iron deficiency. Regardless of weekly B12 injections, folic acid supplements, etc., my hematocrit and hemoglobin never got above 8.6 and 27. Then my gallbladder decided to go out and I had a stone obstructing my liver. When I turned a lovely shade of glowing yellow, it was what we call a clue that something else was wrong. I needed a couple of units of blood before surgery. My blood type is A+, but they still had trouble finding units of blood because of some weird autoantibodies I had. After pumping up me up to H&H of 11 and 30 following transfusion, within a month I was down to 6.2 and 19 with my H&H. Apparently this drop was caused by mass hemolysis, or destruction of red blood cells. Long story short, my GP sent me to a hematologist because my GI doc was ignoring the problem (fired him for this). Turns out I had developed Autoimmune Hemolytic Anemia. Hem/Onc says the hemolytic storm was triggered by the first dose of Reicade I got while in the hospital. Apparently some people with IBD develop AIHA as a part of the disease. It is more common in folks with UC and less common for folks with CD like myself.
02-28-2012, 09:37 AM   #22
David
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Thank you for sharing that KYGirl. What is/was the treatment for the autoimmune hemolytic anemia and did it help?

Do you know what tests and findings there were that allowed him to rule out anemia of chronic disease and diagnose autoimmune hemolytic anemia? Was there an antibody test such as the Coombs’ test?
03-01-2012, 04:42 AM   #23
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The first line of treatment was high dose prednisone. I was on 60 mg daily for almost 6 months, then slowly tapering for the next year. Prednisone was not having the desired effect, so I was given infusions of IVIg (intravenous immunoglobulin G) which is human antibodies. That did not work either. The next step was Rituxin treatments. I had a total of 4 (1 x week for 4 weeks). My blood counts improved marginally after this. I think I improved to an H&H of 9 and 28. The final step for me was splenectomy. The spleen is where blood cells that are tagged by the body for destruction for some reason or other (old, damaged, virus, etc.) are destroyed. Apparently the more blood cells the spleen catches and kills, the bigger the spleen gets, so it can catch and kill more and more, all the while growing bigger and bigger(splenomegaly). The immediate danger of an enlarged spleen in rupture with severe internal bleeding and death if not immediately corrected. My spleen was starting to grow quite a bit. After splenectomy my blood counts improved to H&H of 13 and 39 and have held steady for the past several years.

The testing included both direct and indirect Coomb's tests, serum bilirubin, serum haptoglobin, reticulocyte counts, H&H and RBCs, Urinalysis for hemoglobin and bilirubin, serum lactate dehydrogenase (LDH), and peripheral blood smear. Testing can also differentiate whether it is warm antibody or cold antibody AIHA (warm antibody is most common) as the treament can vary a little accordingly. Hope this helps!
03-22-2012, 12:13 AM   #24
Catherine
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Hi David

It is looks like my daughter Sarah no longer has anemia of chronic disease.
She has had anemia for least 2 year and 9 months (when she first blood test was done). Hemoglobin is now 115 from 90 in only 6 weeks.

Only really change has been treatment for crohn's with pred and aza.

Although she iron levels are unchanged or slightly worse in the same period.
03-22-2012, 08:44 AM   #25
David
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That's good to hear What were her doctor's comments, anything?
03-22-2012, 08:20 PM   #26
Catherine
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I only got the results over the phone with GP and he was more concerned about white cells, iron studies and inflammatory markers. But I did get a copy of the tests and have include them below.

Ferritin 56 ug/L (15-165)
iron 2 umol/L (7-27)
transferrin 2.7 g/L (2.5-3.8)
transferrin sat 3 (13-47)

Comment
Low iron saturation may be seen in inflammatory disorders.

I find the comments on the tests interesting.

I just want to believe she must be getting better, as her hemoglobin has gone up.
04-05-2012, 04:32 AM   #27
Catherine
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Saw gi who said treatment is working as sarah hemoglobin levels rising. Ferritin levels is ok. Other levels haven risen yet as her body is too busy making red blood cells.
04-05-2012, 05:34 AM   #28
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Everytime I get my bloods done, my doctor always says "You're a little anaemic". Not exactly sure what he means by that.

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04-05-2012, 06:00 AM   #29
Catherine
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Mostly likely it means your hemoglobin is a little lower normal for your age and sex. But you want to know is why your hemoglobin is low. Have you had iron studies, folate and b12 tested.
04-06-2012, 08:09 AM   #30
IAmTheWalrus
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They wouldn't be included in a FBC, would it? I can't ever remember specifically getting tested, I thought B12 deficiency, I thought that was only the case for people suffering with their terminal ileum, my Crohn's is specific to my large bowel, so much so it's classified as Crohn's Colitis.

I've never had any problems regarding energy/fatigue, unless I'm flaring. But thanks for the reply, Catherine.
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