Low Iron or Ferritin
 

Hi:

I have had anemia and low white cells soon after starting Herceptin. Both are lower about a week after my treatment and then move up some before my next treatment but never into the normal range. Herceptin causes anemia in about 4% of patients and neutropenia in about 3% so I did not think much of it and have refused the Aranesp for my anemia. My internist, however, at my annual exam ran some more detailed tests such as B12, Ferritin, etc. She found that my iron was 3. The normal range is 15-300. She told me that if my iron reached zero my body will not be able to make iron again. Needless to say I am on slow release iron tablets with blood draws every three weeks to see if I improve.

Have any of you had extremely low iron (Ferritin) levels?

Barbara

This is a interesting post to me because I have an oncologist that never really takes any time to explain things to me no matter how hard I try to get information. But one time she had me come in for a "Iron" infusion. Took four hours.

I wonder how LOW my iron was? I am going to find out now that you posted this because I am concerned because I am just on weekly herceptin now and my wbc and my rbc is not going up like it USE to. I wonder if its because my iron got below 3 like you mentioned?

I love this board because you can learn so much here. Between threads like this and the posts Lani and others find for us...its so very helpful.

I got what I THOUGHT was all my medical files a while ago. But I don't remember seeing my lab work for iron, liver, etc? I go back Monday for herceptin..I will have to ask for those so I can go over them myself.

I am sorry I am of no help here...but I sure appreciate you bringing this up as I could NOT find anyone that had a Iron infusion like I did? I posted here and asked...and not one person except me had one. So now I pray mine wasn't below that 3?

My rbc has been staying much lower then I would like...and by now it should be up there. I kept asking them why it isn't going up like it us too...but never get a answer. Maybe this is why?

Thanks Barbara. Good luck to you. Wishing you well and I hope things get better for you soon!

Hi Barbara, I have low Iron, although I don't know the exact number. I've always been anaemic, running about 11 red blood cell count. It has steadily been going down, and iron studies were done and I was told my Iron was low - when I go next week I'll ask how low.

I cannot tolerate iron pills - they just upset my stomache too much with constipation/diarhea. So now I get weekly iron infusions at my oncs office - much more tolerable and takes about 30-40 minutes. It made my red count go up to 11.6, but then I had my reconstruction surgery and now it's back down to 8.4 (no wonder I'm tired..). So now I'm back to weekly ferrolset infusions and I hope it bounces back up really soon.

jener8er, Where were you hiding out when I asked if anyone here had a iron infusion. lol So someone other then me actually has had one. Yeah...I am not the only one. My first one was four hours long! But the infusion nurse said thats because the 1st time they have to have the pharmacy make up a TEST sample...and SLOWLY infuse it first to see if you will have a reaction. Then if all goes well...they give you the rest. So it was time consuming.

They said if I needed it again...it would not take as long since they would know I had no reaction. But so far...I haven't needed one. (Knock wood.)

I hope they can get Barbara fixed up here soon.

Chelee

Barbara

My Mom, also a breast cancer survivor of 20 years, yes 20 years!!! with 14 positive lymph nodes...has also had a lot of trouble with anemia and low iron...has had several bone marrows, blood transfusions, several tests & all show that her RBC are not shaped right. She is on iron but it was still dropping....started taking it before eating, then waiting 1 hour to eat...made a huge difference. She hasn't had a blood transfusion in 6 months, and her iron continues to rise. Also, if your ferritin levels are low, it can be a bone marrow problem, the way cells are made, so get on top of it, as it can be controlled if caught early. I hope to say some day I am a 20 year survivor like my Mom.

Wow, Sheila, good for your Mom, being a 20-year survivor - I too will be joining that club!

Chelee, I just had my first infusion about a month or 2 ago, so probably when you asked your question, I hadn't had it yet. I had no reaction, and even the first time they didn't take a long time - just about 40 minutes. I'm now back to every week so I HOPE my counts bounce up quick. Where in So Cal are you?

I hope I don't have a marrow problem... I've always been on the low end of normal, so hope it's just the Herceptin. Time will tell.

Ferrous fumarate
 

For those needing iron supplementation iron sulfate the most prescribed pill is not the best as far as absorption & side effects (constipation & abdominal pain) are concerned. There at least two other versions: ferrous gluconate & ferrous fumarate (commercial name: Palafer).

The better alternative is iron fumarate which besides iron includes vitamin C & folic acid. If these 2 added ingredients are not otherwise counterindicated, better absorption & lower incidence of constipation & pain are usually the benefits.
For those who are very sensitive to abdominal pain, taking the pills with meals will generally reduce this side effect. Taking the pills with food tends to reduce absorption but the amount of elemental iron in pills is relatively so high (30mg & up) compared to the maximum ability to absorb iron (about 2mg under average conditions) that this is not going to have a drastic effect on absorption.
However, whether taking the pills with or without food, these diet items should be avoided one or two hours before & after taking the iron pills:

-calcium (pills or in dairy products)
-tea,coffee
-spinach
-bran (& whole grain cereals,breads)

My iron was 4 five months ago. They tried an iron infusion, Ferisol (sp?), to which I had a violent reaction. I've gotten my ferritin up to 31 using Niferex.

Cancer & anemia: treatment options
 

For a detailed presentation of cancer & anemia treatment options see article at:

http://www.her2support.org/vbulletin/showthread.php?p=96991#post96991

Notice that normal Ferritin reading may be false in cancer related anemia & should be replaced by the transfer iron saturation test in determining if there is a true iron deficiency.

Need help re: ferritin
 

Hi,

Just discovered this topic by doing a Search on ferritin. I've been on Herceptin since 1/06. In March my hematocrit and hemoglobin began dropping. In July the hct was 29, hgb 9.9, and MCV 71. Onc made me skip Aug Herceptin tx as he was convinced it was due to Herceptin and advised me to take 3 ferrous gluconate tabs (324 mg) daily plus Vit C 1500 mg.

Sept labs improved to hct 38% (range 34 - 46), hmg 12.2% (1.5 - 15), MCV 79 (80-100) and I resumed Herceptin. At the same time he finally ordered iron studies and the ferritin level was 17 (range of 22-291 normal). I'm also low in Vitamin D. My diet is average but not too much red meat & I don't like fish. I do eat veggies and fruit.

He put in a referral to gastroenterologist to check the GI tract. Still waiting for appt after 2 weeks. Onc seems to think iron pills will solve everything and he's not the least bit interested in Vit D. I'm worried that taking 3 times normal dosage to get better results for anemia/ferritin is only masking a more serious problem. Now taking 1200 mg daily calcium and 1000-1200 Vit D.

If anyone has info on how best to proceed (what tests to ask for), please pass along. No other symptoms except constipation from iron pills. I don't want to push onc too hard as he might cancel Herceptin again. Or am I just overreacting to blood work. Interestingly, my labs were better all through A/C. Thanks so much for your input. I need some shoulders to lean on!
G. Ann - 60 years
Dx 2/04, mastectomy, 4 A/C txs only
Her2+++, stage 2 invasive ductal, grade 3 tumor, 0/18 nodes
16 mos delay for Herceptin

Wierd. I have been anemic most of my adult life due to heavy periods. Now that I'm in chemopause, RBCs are just fine. Herceptin has had no effect. Vitron C and Feosol were the supplements I did pre BC. I think I have read though that iron supplements can aid tumors in building their blood supply. Just food for thought. I did develope mine after doing the supplements. Just a layman. Maybe anemia may signal that all is not well if you have it prior. If you develop after chemo? I just don't know. I think this could be an interesting area of study. Iron did cause loose, sticky tar-like stools for the record. Docs said it usually caused constipation Good luck to all. BB.

Correction on hemoglobin range
 

I goofed when typing the range for hemoglobin. The normal range on my lab result for hmg shows 11.5 to 15. Sorry for typo.

Bev, thanks for comment about possibility of iron supplements aiding blood supply to a tumor. That makes sense and I sure wouldn't want to be aiding the enemy. All the more reason to investigate the cause of drop in lab results. I do have a call into the gastroenterologist dept to find out what the hold up is to be checked out. I was beginning to think I was just overreacting in trying to determine cause.

It's a mine field at times. Between my primary oncologist believing the drop is due to Herceptin and not too concerned about delay to see "GI" doc, but my 2nd opinion oncologist saying "No, it's not due to Herceptin so check it out" (but he carries no clout within my HMO), and the website in heblag01 message saying it's possible to be anemic from chemo, I really don't know. It's hard not to get discouraged with trying to stay on top of things. My justification besides, "I'm worth it" is my need to know I did everything I could to stay on top or ahead of the battle. Thanks again for input-great info.

G. Ann- 60 years
Dx 2/04, mastectomy, 4 A/C txs only
Her2+++, stage 2 invasive ductal, grade 3 tumor, 0/18 nodes
16 mos delay for Herceptin