[curiousG]

Anemia - increased iron storage post transfusions

by curiousG on Fri Oct 03, 2014 1:10 pm

Hi everyone -

I have a quick question after reviewing my mom's bone marrow results. One of the items listed was increased storage iron. This struck me as odd because my mom is very anemic. After researching the term, I realized you can be both.

My mom had three blood transfusions less than two months ago and a Procrit (epoetin alfa) injection.

Mom is still very anemic despite taking daily iron supplements. This was brought up by a nurse yesterday who said she was going to consult mom's oncologist. My fear is that they will want her to do another blood transfusion.

So here are my questions:

1 - Could the previous blood transfusions cause the increased storage iron? If so, does that go away on it's own after some time or is medication needed?

2 - Would getting additional blood transfusions be beneficial or harmful?

3 - Should we ask for them to test mom's ferritin level? Or are there any values in the routine blood work which would indicate an issue?

4 - How can one know if a person needs B12?

5 - Is it likely that once mom starts her myeloma treatment, her anemia will improve?

Thanks for any insight you may be able to offer!

[Toni]

Re: Anemia - increased iron storage post transfusions

by Toni on Fri Oct 03, 2014 8:59 pm

CuriousG,

I'm going to try to help you here, but realize I am not a doctor, just someone who's read a lot here on the Myeloma Beacon.

It looks like you've just joined the Beacon and that your mom has recently been diagnosed? Was her anemia the presenting issue or (presumably) there were multiple issues which caused her physicians to look more closely?

Also, guessing from your message, prior to diagnosis your mother presented as highly anemic so they gave her transfusions? Then other issues caused the diagnosis of multiple myeloma?

So it sounds like, the bone marrow biopsy confirmed it but also showed excess iron stores (this does make sense).

Since the finding of excess iron stores comes from a bone marrow biopsy, it should not be necessary to do a ferritin test as it is a non-invasive way of testing iron stores.

Is it possible you could provide a little more information about your mom's condition and what the oncologist is recommending?

[Toni]

Re: Anemia - increased iron storage post transfusions

by Toni on Fri Oct 03, 2014 9:20 pm

I realized what I didn't share is that yes, your mother's anemia should improve with treatment of her multiple myeloma. It may take some time, but she should improve.

All the best!

[Dr. Prashant Kapoor]

Re: Anemia - increased iron storage post transfusions

by Dr. Prashant Kapoor on Tue Oct 07, 2014 11:34 pm

It would be important to find out the cause of anemia as treatment of anemia is directed towards the underlying etiology. Repeated transfusions can lead to increased iron storage, particularly in a person who is not iron deficient prior to the transfusions. Long-term oral or intravenous iron therapy can have similar effects.

Anemia of chronic disease (AOCD) leads to both decreased iron absorption from the gut and decreased release of iron from macrophages (a type of white blood cell) within the bone marrow and some other sites.

Your questions and answers are provided below.

1. Could the previous blood transfusions cause the increased storage iron? If so, does that go away on it's own after some time or is medication needed?
   
   Yes, repeated packed red blood cell transfusions could lead to increased iron storage. Generally, iron chelators [drugs that remove iron from the body] are not used for increased iron storage from transfusions due to the side effects of chelators. If erythropoietin or Procrit is used for AOCD, over time the iron stores of marrow should normalize.
   
   
2. Would getting additional blood transfusions be beneficial or harmful?
   
   This is a tricky question to answer. One has to consider blood transfusions only for appropriate indications. Outside of those specific indications, blood products should not be transfused, since there are risks involved.
   
   
3. Should we ask for them to test mom's ferritin level? Or are there any values in the routine blood work which would indicate an issue?
   
   Iron studies, including ferritin, total iron binding capacity, and serum iron levels, should be performed as part of work-up of anemia of undetermined etiology.
   
   
4. How can one know if a person needs B12?
   
   By checking Vitamin B12 level and methyl malonic acid level.
   
   
5. Is it likely that once mom starts her myeloma treatment, her anemia will improve?
   
   It depends on the cause of anemia. If myeloma is completely, or in part, responsible for anemia, it should improve with the treatment of myeloma.

[curiousG]

Re: Anemia - increased iron storage post transfusions

by curiousG on Thu Oct 30, 2014 3:35 pm

Thank you Toni and Dr. Prashant Kapoor for your replies.

Toni -

My sister posted awhile back which has some background information about our mom and what lead to diagnosis:

"Trying to understand mother's test results," Beacon forum discussion started Sep 5, 2014.

Our mom's Hgb has hovered around +/- 7.7g/dL (range:12.0 - 16.0) since she was released from the hospital in August. Until yesterday, her anemia had not been addressed. Yesterday, she received two blood transfusions and instantly felt better. Though she had some flushing and told me this morning she vomited last night (she stated she felt better afterwards). She seems to be doing okay today.

Mom is on week three of her first round of CyBorD treatment. Other than weekly CBCs, no other tests have been run. Hopefully next week we will get some encouraging news! =)

Thanks again for the information you provided!