raising low ferritin levels with iron supplementation

[Mprtz]

I've donated whole blood and platelets a bunch of times since starting TRT. Partly to keep my hct down, but perhaps more than I have had to.

I've read here (mostly from Apollon) that frequent blood donation could lead to low ferritin levels, and on my last self ordered test, I included it.
Sure enough, ferritin came in low:

Ferritin, Serum 11 LOW 30-400 ng/mL

So I have started taking an iron supplement ( ferrous fumarate ) to try to bring this back up. That contains 18mg elemental iron and is supposed to be 100% RDA.

Any suggestions on what the most effective serving size is? I've been taking one a day.

 

[Jimstigator]

Just recently - I brought this up with my Dr. He stated he wanted me to stop donating so much. He said the effects of low iron/ferritin can cause alot of issues. He actually said unless my HCT gets near like 53, to back off the donations.

I haven't really decided what to do yet, but I can confirm what you are saying. Prior to TRT or donating blood, my ferritin was actually high... like 500. I donated twice since starting TRT and my last reading was like 120. I eat iron rich foods but do not supplement.

-Jim

 

[Mprtz]

Did he mention what any of these issues might be?

I found the following information:

"The Office of Dietary Supplements notes that different types of iron supplements contain varying percentages of elemental iron. For this reason, the dosage or total milligrams of an iron supplement you can take before toxicity occurs depends upon the form of iron in your supplement. Ferrous fumarate supplements contain 33 percent elemental iron. The upper limit of intake for these supplements without a doctor's supervision is 136 milligrams per day, which gives you only 45 milligrams of elemental iron."

This translates to about 3 of my pills a day. Based on this I will increase my intake somewhat.

I also found the following study interesting, which argues that blood donors should be tested for ferritin as well as hemoglobin:

Iron Balance in Regular Blood Donors

 

[Alpin]

Happened to me too MPRTZ....
I donated 2 times every two months and prior donated every three months a couple times.
Ferritin went below range...
its not healthy either. Too low of iron after donating increases the risk of stroke.

 

[Alpin]

You are better off with iron bisglycinate. Non constipating and easily absorbed.

 

[Black Beard]

Iron bisglycinate is good, lots of red meat too.

 

[Alpin]

I don't know what TT you are at but if it were me I would come down to 600 ng/dl....and fast if HCT is that much of a problem I would try to slow things down. You're going to need at least 25 mg a day of a highly absorbable iron like bysglycinate.
I would not donate another pint of blood with those anemic levels of Ferritin. It's dangerous.

 

[Mprtz]

My TT is pretty high, probably around 1200 whi no doubt is contributing to hct going up.
I don't know that I need to be donating as much as I do... I just got into it and donated as much as possible.

While reducing my dose is something I might have to consider, I'm kind of attached to how I look and feel at the higher level and I'm afraid that I'll lose much of my perceived benefits at 600.

For now, my plan is to see if I can raise my ferritin by taking iron supplements. Probably about 50mg (iron) per day. I will re-test ferritin in a few months and see how effective that is without making any other changes.

 

[Mprtz]

I'm also going to be closely watching for symptoms of low ferritin: shortness of breath, increased muscle soreness and irregular heartbeat.

 

[Alpin]

My TT is pretty high, probably around 1200 whi no doubt is contributing to hct going up.
I don't know that I need to be donating as much as I do... I just got into it and donated as much as possible.

While reducing my dose is something I might have to consider, I'm kind of attached to how I look and feel at the higher level and I'm afraid that I'll lose much of my perceived benefits at 600.

For now, my plan is to see if I can raise my ferritin by taking iron supplements. Probably about 50mg (iron) per day. I will re-test ferritin in a few months and see how effective that is without making any other changes.

Iron supps will speed up the HCT climbing.

 

[Alpin]

I'm also going to be closely watching for symptoms of low ferritin: shortness of breath, increased muscle soreness and irregular heartbeat.

Thyroid is effected too. I had really cold hands and feet for a month or so following a donation that took my ferritin down to 17.

 

[halfwit]

Platelet apheresis does not impact ferritin nearly as much for those that tend to see higher HCT and are noticing lower ferritin levels. It lowers hematocrit significantly, but has a much lower impact on iron stores. I recommend those of you that are in this boat to look into it.

I've been donating in this fashion for several years now and am consistently well within range.

My .02c

Edit: My statement about ferritin is NOT just based on my experience in this case. There are numerous studies showing this as well.

 

[Mprtz]

Iron supps will speed up the HCT climbing.

Maybe, but attempting to control HCT via iron starvation doesn't seem to be a good option either.

Looking at my CBC, what strikes me is that RBC count is still slightly high, HCT is in range, but MCH (mean corpuscular hemoglobin) is low, which I interpret as hepcidin suppression still making me make lots of red blood cells, but lack of iron causing them to have less hemoglobin.

 

[Mprtz]

Platelet apheresis does not impact ferritin nearly as much for those that tend to see higher HCT and are noticing lower ferritin levels. It lowers hematocrit significantly, but has a much lower impact on iron stores. I recommend those of you that are in this boat to look into it.

I've been donating in this fashion for several years now and am consistently well within range.

My .02c

Edit: My statement about ferritin is NOT just based on my experience in this case. There are numerous studies showing this as well.

I'd be interested in those references. Doesn't make much sense on the face of it, because platelet apheresis really only lowers HCT though red cell loss (platelet volume being such a small fraction of blood solids), and all red cell loss should be the same as far as loss of iron stores goes.

Most of my donations have been platelets, but I've donated whole blood pretty regularly as well. I will consider switching to platelets only.

 

[Megatron28]

mprtz the hematologist!!!

 

[Mprtz]

Thyroid is effected too. I had really cold hands and feet for a month or so following a donation that took my ferritin down to 17.

I'll watch out for that too. My ferritin was 11, but I have no noticeable symptoms. Thyroid profile was normal too.

 

[Mprtz]

Well I have to concede that my effort to raise ferritin via iron supplementation was a spectacular failure.

I took about 60mg elemental iron per day for about 3 months. I believe I donated blood once during that period.

On my next blood test, my hct had jumped to 53. I discontinued the iron supplementation.

A few weeks later, I re-tested serum ferritin and it had only gone up to 17 (from 11) still well under bottom of range (30). Hct was again at 53, even though I had donated whole blood in the interim.

So Apollon was (once again) right that iron supps would speed my rise in hct. I guess I would really need to understand the complexities of iron metabolism to understand why this works the way it does. To me, it is counterintuitive.

I had envisioned serum ferritin as a sort of "reservoir" of bound iron from which iron is drawn to create hemoglobin. The results I got do not fit that model at all.

I'd love to believe HW's assertion that plateletpheresis lowers hct without a concomitant reduction in ferritin, but it's hard to accept it absent a plausible mechanism how this would possibly be so.

 

[Megatron28]

Well I have to concede that my efforts to raise ferritin via iron supplementation was a spectacular failure.

I took about 60mg elemental iron per day for about 3 months. I believe I donated blood once during that period.

On my next blood test, my hct had jumped to 53. I discontinued the iron supplementation.

A few weeks later, I re-tested serum ferritin and it had only gone up to 17 (from 11) still well under bottom of range (30). Hct was again at 53, even though I had donated whole blood in the interim.

So Apollon was (once again) right that iron supps would speed my rise in hct. I guess I would really need to understand the complexities of iron metabolism to understand why this works the way it does. To me, it is counterintuitive.

I had envisioned serum ferritin as a sort of "reservoir" of bound iron from which iron is drawn to create hemoglobin. The results I got do not fit that model at all.

I'd love to believe HW's assertion that plateletpheresis lowers hct without a concomitant reduction in ferritin, but it's hard to accept it absent a plausible mechanism how this would possibly be so.

You had me a "concede".

 

[Mprtz]

You had me a "concede".

 

[Mprtz]

Thinking about it, I did come up with a possible mechanism whereby plateletpheresis might lower hct without leading to iron depletion.

Unlike whole blood, where the blood and all its constituents are removed from the body, the hct drop associated with plateletpheresis is largely due to hemolysis (destruction of red blood cells) caused by the pumping process.

Perhaps when red blood cells are destroyed and the resulting waste products are processed by the liver, the iron is reabsorbed rather than excreted?