What causes my anemia?

[Bananom]

I have microcytic anemia.
Hb at 11.6
Hkt at 36
MCH at 26


Iron is 155. Ferritin is 406.
Folic acid 9.4 ng/ml [3.9-26.9]
B12 at 297, currently doing injections with no success
Vitamin E at 1446 [500-2000 mcg/dl]
Vitamin A at 81.2 [30-70 mcg/dl]
Vitamin B1 93.2 [28-85mcg/dl]
Vitamin B6 8.3 [4.8-36.9 ng/ml]
Taking copper everyday 1:5 ratio to zinc.

What the hell am I missing??? Could the blood test be off? I am wondering this because the clinic forgot to test my blood, and I called to remind them after one week.
So my blood has been laying around for one week...

 

[Michaelk3]

I have microcytic anemia.
Hb at 11.6
Hkt at 36
MCH at 26


Iron is 155. Ferritin is 406.
Folic acid 9.4 ng/ml [3.9-26.9]
B12 at 297, currently doing injections with no success
Vitamin E at 1446 [500-2000 mcg/dl]
Vitamin A at 81.2 [30-70 mcg/dl]
Vitamin B1 93.2 [28-85mcg/dl]
Vitamin B6 8.3 [4.8-36.9 ng/ml]
Taking copper everyday 1:5 ratio to zinc.

What the hell am I missing??? Could the blood test be off? I am wondering this because the clinic forgot to test my blood, and I called to remind them after one week.
So my blood has been laying around

Just because your H&H is slightly low doesnt mean you are anemic. Could be dilutional (you drank too much water before your test) or maybe you have a mild infection. worst case, you havw a small internal bleed. your ferritin is really high though..

 

[Bananom]

Just because your H&H is slightly low doesnt mean you are anemic. Could be dilutional (you drank too much water before your test) or maybe you have a mild infection. worst case, you havw a small internal bleed. your ferritin is really high though..

My Hb used to be at 15.6

 

[Michaelk3]

My Hb used to be at 15.6

How long ago? 15.6 is nearly too high. If it was very recent a drop to 11.6 is indicative of a bleed. but unless you are hypotensive and showing signs of bleeding, it is likely related to the reasons i posted originally.

 

[Bananom]

How long ago? 15.6 is nearly too high. If it was very recent a drop to 11.6 is indicative of a bleed. but unless you are hypotensive and showing signs of bleeding, it is likely related to the reasons i posted originally.

months ago

 

[ccousz]

Liver enzymes? Kidney function? Weight? Need a lot more info

 

[Bananom]

Liver enzymes? Kidney function? Weight? Need a lot more info

Liver enzymes fine, optimal even same for kidney
72 Kg
1.76m

 

[cs3000]

I have microcytic anemia.
Hb at 11.6
Hkt at 36
MCH at 26


Iron is 155. Ferritin is 406.
Folic acid 9.4 ng/ml [3.9-26.9]
B12 at 297, currently doing injections with no success
Vitamin E at 1446 [500-2000 mcg/dl]
Vitamin A at 81.2 [30-70 mcg/dl]
Vitamin B1 93.2 [28-85mcg/dl]
Vitamin B6 8.3 [4.8-36.9 ng/ml]
Taking copper everyday 1:5 ratio to zinc.

What the hell am I missing??? Could the blood test be off? I am wondering this because the clinic forgot to test my blood, and I called to remind them after one week.
So my blood has been laying around for one week...

#1 covid can damage red blood cells , your ferritin being high with low hemoglobin is a red flag for that
you specifically mentioned microcytic anemia , and covid changes red blood cell shape (makes them smaller , like in microcytic anemia)
https://www.ncbi.nlm.nih.gov/pmc/ar... significant changes,has been recorded [107].
"Kubancova et al. found significant phenotypic changes in RBCs from COVID-19 recovered patients. RBCs are less deformable, smaller, and more heterogeneous in size and deformation "
temporary run of 1.5g arginine + 500mg x2 daily can help get rid of long covid if you still have it


#2 How much zinc? zinc by itself without enough iron intake reduces the iron related blood markers. in general use there's not much need for >10mg zinc .
that's basically as effective as high doses for immunity A Case-Control Study for the Effectiveness of Oral Zinc in the Prevention and Mitigation of COVID-19

#3 do you get enough riboflavin? low riboflavin increases iron loss. & correcting riboflavin helps correct hemoglobin. (crazy high doses aren't needed ~3mg should cover it)
"One study assessing riboflavin repletion found that supplementation was able to increase riboflavin stores in the body after six weeks (1.6mg daily)[41] with higher doses (2-4mg) being able to increase stores at four weeks, with levels remaining elevated over eight weeks.[42] After supplementation is ceased, riboflavin stores have been shown to return to baseline after six months.[41]"

#4 do you cook with aluminium pans? it works opposite to iron. decreases iron related blood markers. if you don't know one way to tell is using a fridge magnet on the top part of the pan. usually bottom parts are magnetic but aluminium doesnt respond to fridge magnets

if you take high dose aspirin that can contribute to anemia too

 

[Bananom]

#1 covid can damage red blood cells , your ferritin being high with low hemoglobin is a red flag for that
you specifically mentioned microcytic anemia , and covid changes red blood cell shape (makes them smaller , like in microcytic anemia)
https://www.ncbi.nlm.nih.gov/pmc/ar... significant changes,has been recorded [107].
"Kubancova et al. found significant phenotypic changes in RBCs from COVID-19 recovered patients. RBCs are less deformable, smaller, and more heterogeneous in size and deformation "
temporary run of 1.5g arginine + 500mg x2 daily can help get rid of long covid if you still have it


#2 How much zinc? zinc by itself without enough iron intake reduces the iron related blood markers. in general use there's not much need for >10mg zinc .
that's basically as effective as high doses for immunity A Case-Control Study for the Effectiveness of Oral Zinc in the Prevention and Mitigation of COVID-19

#3 do you get enough riboflavin? low riboflavin increases iron loss. & correcting riboflavin helps correct hemoglobin. (crazy high doses aren't needed ~3mg should cover it)
"One study assessing riboflavin repletion found that supplementation was able to increase riboflavin stores in the body after six weeks (1.6mg daily)[41] with higher doses (2-4mg) being able to increase stores at four weeks, with levels remaining elevated over eight weeks.[42] After supplementation is ceased, riboflavin stores have been shown to return to baseline after six months.[41]"

#4 do you cook with aluminium pans? it works opposite to iron. decreases iron related blood markers. if you don't know one way to tell is using a fridge magnet on the top part of the pan. usually bottom parts are magnetic but aluminium doesnt respond to fridge magnets

if you take high dose aspirin that can contribute to anemia too

How does aspirin contribute to anemia? I like to take 6 grams per day

 

[redsun]

How does aspirin contribute to anemia? I like to take 6 grams per day

Causes bleeding in the gut especially in high doses. So it doesnt matter if you have everything you need you are constantly bleeding yourself out. No wonder your hemoglobin and hematocrit is so bad. I would say this is probably the biggest contributor.

Your hematocrit being low shows that the volume of red cells in your blood percentage wise is getting low, meaning you literally have less blood than normal which is probably from you slowly losing blood from aspirin. And this obviously also shows as less hemoglobin as well.

Stop aspirin completely your numbers should improve within a few weeks.

 

[Bananom]

Causes bleeding in the gut especially in high doses. So it doesnt matter if you have everything you need you are constantly bleeding yourself out. No wonder your hemoglobin and hematocrit is so bad. I would say this is probably the biggest contributor.

Your hematocrit being low shows that the volume of red cells in your blood percentage wise is getting low, meaning you literally have less blood than normal which is probably from you slowly losing blood from aspirin. And this obviously also shows as less hemoglobin as well.

Stop aspirin completely your numbers should improve within a few weeks.

How do I know I am bleeding from aspirin? I never had blood in my stools or even nosebleeds

 

[redsun]

How do I know I am bleeding from aspirin? I never had blood in my stools or even nosebleeds

Stool may be black or tarry but this isn't a guarantee. Sometimes its obvious but not always.

 

[cs3000]

How does aspirin contribute to anemia? I like to take 6 grams per day

thats a lot
can be through bleeds like redsun mentioned, but also through suppressing erythropoiesis / red blood cell generation , aspirin altering red blood cell shape & size, or maybe through increased red blood cell destruction

https://tspace.library.utoronto.ca/retrieve/4820/ph04075.pdf

https://www.ijp-online.com/article....volume=36;issue=4;spage=226;epage=230;aulast=
OBJECTIVE: To examine the acute and chronic effects of aspirin on peripheral blood and bone marrow counts and hepatic ferritin expression in mice. MATERIAL AND METHODS: Adult male albino mice were orally administered aspirin at a dose of 600 mg/kg thrice daily for 7 days or 150 mg/kg once daily for 6/7 days up to 25 weeks. [<1g human dose daily]
At the end of the experiment the red and white blood cell counts, hemoglobin, and packed cell volume were estimated. Bone marrow films were studied to estimate the rate of erythropoiesis and leucopoiesis. Expression of liver ferritin was tested by immunohistochemistry.
RESULTS: Acute or chronic doses of aspirin reduced the RBC count, hemoglobin and other red cell indices as compared to controls.
The WBC counts were higher in the treated animals as compared to the untreated animals. Both the treatment regimens appeared to suppress the rate of erythropoiesis in the marrow, while the rate of leucopoiesis appeared to increase in the marrow of the treated animals. Aspirin treatment did not significantly affect the expression of ferritin in the liver.
CONCLUSION: Aspirin in either acute or chronic doses induces anemia associated with leucocytosis in mice; the anemia does not seem to be induced due to alterations in iron metabolism. The drug appears to use multiple targets which affect red cell production and maturation processes.

At the biochemical level, aspirin alters red cell membrane functions by inhibiting cholinesterase and ion-dependent ATPase activity and by altering the ion permeability across the cell wall.11, 16, 17 With these defects along with altered cell shape, it is reasonable to assume that the cells may be more susceptible to intravascular hemolysis. Although, in the present study, no specific test was performed to confirm the occurrence of hemolysis in vivo, hemoglobin pigment was detected in some of the renal elements and free hemoglobin was also detected in the plasma of some of the acutely treated mice (data not shown). Both these observations are reported as indicators of hemolysis in vivo. 9 Thus, it appears that intravascular hemolysis may be a major contributing factor for the reduced red cell counts observed in the present study. Hemolytic anemia has been reported with the use of aspirin in humans, especially in cases with certain hemoglobinopathies.3

the rate of erythropoiesis in the treated animals appeared depressed, probably indicating Ep deficiency. This speculation is supported by the fact that since there is a direct relationship between the renal prostaglandin levels and Ep production,8 inhibition of prostaglandin production by aspirin (through inhibition of cyclooxygenase-2) 19 may reduce renal erythropoietin production. It is possible that the reduction in Ep production may further aggravate the anemia already induced by aspirin in the treated animals


small study but both groups showed same effect,
(see how their red blood diameter is smaller too, microcytic anemia with diameter dropping)
aside from that downside something interesting is aspirin raises the white counts a lot. but i wonder if thats a positive or a negative associated with the red blood markers dropping

 

[Bananom]

Stool may be black or tarry but this isn't a guarantee. Sometimes its obvious but not always.

Can you think of any other causes for my anemia?

 

[Bananom]

thats a lot
can be through bleeds like redsun mentioned, but also through suppressing erythropoiesis / red blood cell generation , aspirin altering red blood cell shape & size, or maybe through increased red blood cell destruction

https://tspace.library.utoronto.ca/retrieve/4820/ph04075.pdf

https://www.ijp-online.com/article....volume=36;issue=4;spage=226;epage=230;aulast=
OBJECTIVE: To examine the acute and chronic effects of aspirin on peripheral blood and bone marrow counts and hepatic ferritin expression in mice. MATERIAL AND METHODS: Adult male albino mice were orally administered aspirin at a dose of 600 mg/kg thrice daily for 7 days or 150 mg/kg once daily for 6/7 days up to 25 weeks. [<1g human dose daily]
At the end of the experiment the red and white blood cell counts, hemoglobin, and packed cell volume were estimated. Bone marrow films were studied to estimate the rate of erythropoiesis and leucopoiesis. Expression of liver ferritin was tested by immunohistochemistry.
RESULTS: Acute or chronic doses of aspirin reduced the RBC count, hemoglobin and other red cell indices as compared to controls.
The WBC counts were higher in the treated animals as compared to the untreated animals. Both the treatment regimens appeared to suppress the rate of erythropoiesis in the marrow, while the rate of leucopoiesis appeared to increase in the marrow of the treated animals. Aspirin treatment did not significantly affect the expression of ferritin in the liver.
CONCLUSION: Aspirin in either acute or chronic doses induces anemia associated with leucocytosis in mice; the anemia does not seem to be induced due to alterations in iron metabolism. The drug appears to use multiple targets which affect red cell production and maturation processes.

At the biochemical level, aspirin alters red cell membrane functions by inhibiting cholinesterase and ion-dependent ATPase activity and by altering the ion permeability across the cell wall.11, 16, 17 With these defects along with altered cell shape, it is reasonable to assume that the cells may be more susceptible to intravascular hemolysis. Although, in the present study, no specific test was performed to confirm the occurrence of hemolysis in vivo, hemoglobin pigment was detected in some of the renal elements and free hemoglobin was also detected in the plasma of some of the acutely treated mice (data not shown). Both these observations are reported as indicators of hemolysis in vivo. 9 Thus, it appears that intravascular hemolysis may be a major contributing factor for the reduced red cell counts observed in the present study. Hemolytic anemia has been reported with the use of aspirin in humans, especially in cases with certain hemoglobinopathies.3

the rate of erythropoiesis in the treated animals appeared depressed, probably indicating Ep deficiency. This speculation is supported by the fact that since there is a direct relationship between the renal prostaglandin levels and Ep production,8 inhibition of prostaglandin production by aspirin (through inhibition of cyclooxygenase-2) 19 may reduce renal erythropoietin production. It is possible that the reduction in Ep production may further aggravate the anemia already induced by aspirin in the treated animals


small study but both groups showed same effect,
(see how their red blood diameter is smaller too, microcytic anemia with diameter dropping)
aside from that downside something interesting is aspirin raises the white counts a lot. but i wonder if thats a positive or a negative associated with the red blood markers dropping
View attachment 46531

Can you think of any other causes for my anemia?

 

[redsun]

Can you think of any other causes for my anemia?

No. Its pretty obvious what it is. cs3000 went even more in depth on why its the megadosing aspirin. If you want your anemia to stay the same or continue to get worse, stay on the aspirin.

 

[cs3000]

Can you think of any other causes for my anemia?

I'd bet most of it's caused by the aspirin considering you've been on very high dose for a while, even 1 gram is enough to do that over time by the study
+ you've had long covid which also probably contributed a lot to that along with the aspirin. considering your ferritin is high which implies inflammation/infection. that much aspirin might have even worsened the long covid by increasing certain cytokines

so if i were in your situation i'd focus on those first & eat red meat daily with a couple miligrams of riboflavin, & see how you progress

 

[PopSocket]

Redo test. Check for autoimmune hemolytic anemia. Check anti-mpo and other autoantibodies. vit E protects the RBCs. Stop aspirin.

 

[cs3000]

I'd bet most of it's caused by the aspirin considering you've been on very high dose for a while, even 1 gram is enough to do that over time by the study
+ you've had long covid which also probably contributed a lot to that along with the aspirin. considering your ferritin is high which implies inflammation/infection. that much aspirin might have even worsened the long covid by increasing cytokines

so if i were in your situation i'd focus on those first & eat red meat daily with a couple miligrams of riboflavin, & see how you progress

Aspirin Is Related to Worse Clinical Outcomes of COVID-19 Aspirin Is Related to Worse Clinical Outcomes of COVID-19
. Conclusions
Aspirin use before the diagnosis of COVID-19 tended to increase the death rate, and aspirin use after the diagnosis of COVID-19 tended to increase the conventional oxygen therapy rate, compared to no use. Analysis with a larger sample size is required to confirm the adverse effects of aspirin on COVID-19, and further research for mechanisms is needed.