Hi,
Does anyone know if a decreasing hemoglobin count in asymptomatic myeloma can be 'helped' by eating more iron rich foods. I've been told that it can, and I've also read that it makes no difference as the low levels are mostly down to biological processes.
The levels have dropped from 13.5 in the middle of June down to 12.6 at the end of September and I'm quite bothered about the rate of change.
Thanks.
Forums
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scoobydoo - Name: Scott
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: September 2010
- Age at diagnosis: 42
Re: Asymptomatic Myeloma Hemoglobin count
Decreasing hemoglobin, i.e. worsening anemia, can have any number of causes. It could be related to 1) inadequate production (from too many myeloma cells decreasing the capacity of your marrow to allow normal red blood cell precursors to mature and make it to your peripheral blood), 2) blood loss from obvious or hidden sources (small amounts of blood can seep into your stool without changing your stool color), or 3) destruction of your blood cells while in your arteries and veins, a cause that is rarely seen in myeloma patients but can still occur.
If causes #2 and #3 have been ruled out, the criteria by International Myeloma Working Group (British Journal of Haematology, 2003) for your anemia to be most likely related to your myeloma is for your hemoglobin to drop 2 g/dL below the lower limit of normal OR less than 10 g/dL. At 12.6, you still have a way to go but if you go from 13.5 to 12.6 to 11.5 in November for example, I think this would be a clear trend and should prompt restaging of your myeloma by non-invasive measures such as repeat myeloma survey (xrays) and repeat blood tests to check on kidney function and calcium level.
Our goal as physicians is to try to catch your myeloma BEFORE you become symptomatic from your anemia, develop [compression] fractures, or lose any kidney function.
If causes #2 and #3 have been ruled out, the criteria by International Myeloma Working Group (British Journal of Haematology, 2003) for your anemia to be most likely related to your myeloma is for your hemoglobin to drop 2 g/dL below the lower limit of normal OR less than 10 g/dL. At 12.6, you still have a way to go but if you go from 13.5 to 12.6 to 11.5 in November for example, I think this would be a clear trend and should prompt restaging of your myeloma by non-invasive measures such as repeat myeloma survey (xrays) and repeat blood tests to check on kidney function and calcium level.
Our goal as physicians is to try to catch your myeloma BEFORE you become symptomatic from your anemia, develop [compression] fractures, or lose any kidney function.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
Re: Asymptomatic Myeloma Hemoglobin count
I forgot to answer your question. Eating more iron only helps if you are acutely or chronically losing blood and you develop iron deficiency. It's very reasonable to have your doctor check a ferritin level at some point to evaluate your iron stores -- this blood test is not perfect, but might have the best ratio of benefits:cost.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
Re: Asymptomatic Myeloma Hemoglobin count
Hello Dr. Hofmeister ... thanks for answering another question here on the forum.
Forgive me if I'm being a bit dense. I just want to make sure I understand what you wrote. Are you saying that, if your hemoglobin is going down for the usual reasons associated with multiple myeloma, then getting more iron into your system through diet or supplements won't increase your hemoglobin levels?
Forgive me if I'm being a bit dense. I just want to make sure I understand what you wrote. Are you saying that, if your hemoglobin is going down for the usual reasons associated with multiple myeloma, then getting more iron into your system through diet or supplements won't increase your hemoglobin levels?
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BarbSG
Re: Asymptomatic Myeloma Hemoglobin count
Exactly. If your hemoglobin is going down due to progression of myeloma or worsening of kidney function (for whatever reason), getting more iron into your system through diet or supplements will definitely not increase your hemoglobin levels. Iron supplementation in general is only for patients with proven iron deficiency or for selected patients receiving Aranesp/Epogen.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
Re: Asymptomatic Myeloma Hemoglobin count
Thanks Dr. Hofmeister! I appreciate the clarification. Its really helpful.
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BarbSG
Re: Asymptomatic Myeloma Hemoglobin count
Thanks Doctor, that certainly makes some sense, and funnily enough I couldn't find a definitive answer anywhere else.
I'll ask the Hematologist about it in more detail when I go back, and post any info I have as it may help someone else.
I'll ask the Hematologist about it in more detail when I go back, and post any info I have as it may help someone else.
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scoobydoo - Name: Scott
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: September 2010
- Age at diagnosis: 42
Re: Asymptomatic Myeloma Hemoglobin count
I was diagnosed with multiple myeloma on Feb. 14, 2012. my hemaglobin count last week was at 10.8.... 3 weeks before that it was at 10.0... Is the chemo therapy helping with this?( I have had 3 sessions, one a week) or is it too soon to have done anything?
The other thing my oncologist told me to look at was the U Protein levels. I understand that the average protein in urine is < 0.2 , mine currently is at 1.9. does this mean my kidneys are getting damaged and failing??
Thank you.
Ps. I am a 46 year old male
The other thing my oncologist told me to look at was the U Protein levels. I understand that the average protein in urine is < 0.2 , mine currently is at 1.9. does this mean my kidneys are getting damaged and failing??
Thank you.
Ps. I am a 46 year old male
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WG123
Re: Asymptomatic Myeloma Hemoglobin count
I was Dx'd with Smolderig Myeloma in 12/2011. My Hemoglobin bounces around a bit. I have seen it at 12.8 and as Low as 11.4. It seems to follow a pattern. It will decrease for a period of time (2-3 months) then rise. I will find out what it is in 2 weeks but last test 2 weeks ago it was 12.0 which was up from 11.7 and before that was the lowest at 11.4. Is that Normal? I have been taking Spirulina which I have been told helps RBC's is this possibly helping? My RBC's are steadily low at 3.8-3.9 and WBC's are normal.
Thanks
Art
Thanks
Art
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Art - Name: Art
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2011
- Age at diagnosis: 40
Re: Asymptomatic Myeloma Hemoglobin count
When I was diagnosed (winter 2010) I had a bleeding disorder of sorts and was having blood in my nose/ bowel bleeding. I was very anemic (around 80 hemoglobin). I was told to take a lot of iron supplements (elemental iron pills) but they did not bring the level up. Eventually had two IV iron infusions and it brought the level up before my transpplant.
The transplant nurse (most patients consider him quite rude and insulting in a way) told me that "myeloma does not cause iron deficiency", so in his opinion, "he should not have to do this blood test (to check irorn) or arrange the IV with the transfusion centre". 'what a dolt. I told him well in rare cases myeloma causes bleeding disorders so he should know that, and yours truly was one of those cases.
The transplant nurse (most patients consider him quite rude and insulting in a way) told me that "myeloma does not cause iron deficiency", so in his opinion, "he should not have to do this blood test (to check irorn) or arrange the IV with the transfusion centre". 'what a dolt. I told him well in rare cases myeloma causes bleeding disorders so he should know that, and yours truly was one of those cases.
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sunshine
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