Might my anemia and lowered hemoglobin be related to MAC?

@irenea8. The docs have never called my Pseudomonas "chronic." There have been periods over the last 5 years that sputum did not show it but it always returns. Currently I'm on Tobramycin twice a day. I neb two weeks on and two weeks off. I'm going to send my pulmonary doc a portal message and ask questions and hopefully get something back before my early AM iron infusion Wed. The iron infusion was ordered by my primary so the pulmonary doc is not aware. Thanks.

my sputum samples include mucoid strain of Pseudomonas which is considered chronic form of it.

Newbie here but...
I have low iron etc. right now. I have pseudomonas colonies. My regular DR wants me to take iron pills but I have been told by a rheumatologist that there is something called anemia of chronic disease whereby iron is "hidden" in your blood from invaders (like pseudomonas, certain cancers etc) so that they don't feed on it and it can be dangerous to take iron in that situation. There are apparently additional blood tests that can attempt to sort out whether it is a true iron deficiency anemia or this other iron hiding out situation. (Don't know which tests). I am checking now with my infectious disease doctor for advice on the problem. If you have normal ferritin (blood work) you may not have iron deficiency anemia but that requires medical judgment. If I learn more I will post.

Newbie here but...
I have low iron etc. right now. I have pseudomonas colonies. My regular DR wants me to take iron pills but I have been told by a rheumatologist that there is something called anemia of chronic disease whereby iron is "hidden" in your blood from invaders (like pseudomonas, certain cancers etc) so that they don't feed on it and it can be dangerous to take iron in that situation. There are apparently additional blood tests that can attempt to sort out whether it is a true iron deficiency anemia or this other iron hiding out situation. (Don't know which tests). I am checking now with my infectious disease doctor for advice on the problem. If you have normal ferritin (blood work) you may not have iron deficiency anemia but that requires medical judgment. If I learn more I will post.

Hi Liz440. Your post is very timely for me. I've recently been diagnosed with iron deficiency anemia--had a GI bleed 2 months ago. Just 3 days ago I went for confirmation and to be set up for iron infusion. The did blood work and my ferritin was within the normal range but on the lower side. So... I'm very interested if you (or someone else) can answer the question about having "hidden" iron. I have two "??chronic lung infections" and don't need something that may interfere with treatments. Thanks much.

Hi Liz440. Your post is very timely for me. I've recently been diagnosed with iron deficiency anemia--had a GI bleed 2 months ago. Just 3 days ago I went for confirmation and to be set up for iron infusion. The did blood work and my ferritin was within the normal range but on the lower side. So... I'm very interested if you (or someone else) can answer the question about having "hidden" iron. I have two "??chronic lung infections" and don't need something that may interfere with treatments. Thanks much.

My understanding is that ferritin is the primary test used to differentiate a true iron deficiency from anemia of inflammation, but the results are not always clearly interpretable. Ferritin is a protein involved in iron storage. When it is low, it pretty clearly suggests that there are not sufficient stores of iron. Often, if the body is sequestering iron to keep it away from a pathogen (i.e., anemia of inflammation or anemia of chronic disease), ferritin will be normal or even elevated because there is stored iron, but iron levels are low because the body is playing keep away with the bacteria. That said, it remains a judgment call with normal ferritin levels because ferritin levels can be artifactually increased by some other factors without there actually being sufficient iron stores. In other words, you can have a true iron deficiency anemia superimposed on an anemia of inflammation/chronic disease. I think it is important to talk to your doctor(s) about all of your test results and the pros and cons in your case given the GI bleed. While it is generally not ideal to give iron when there is an active infection, it seems that the results of studies regarding iron supplementation and infection risk are actually a bit muddy, and many have concluded that the risk-benefit ratio is likely to be specific to the individual context. I actually had anemia of inflammation and did not treat it (which was appropriate). I later had significant bleeding, developed clear IDA with low ferritin, and I have had iron supplementation. Basically, it seems that, most of the time, for people with chronic infections, it seems to make the most sense not to take iron for a mild anemia with normal ferritin. However, as the situation gets more complicated, the decisions get more complicated as well.

My understanding is that ferritin is the primary test used to differentiate a true iron deficiency from anemia of inflammation, but the results are not always clearly interpretable. Ferritin is a protein involved in iron storage. When it is low, it pretty clearly suggests that there are not sufficient stores of iron. Often, if the body is sequestering iron to keep it away from a pathogen (i.e., anemia of inflammation or anemia of chronic disease), ferritin will be normal or even elevated because there is stored iron, but iron levels are low because the body is playing keep away with the bacteria. That said, it remains a judgment call with normal ferritin levels because ferritin levels can be artifactually increased by some other factors without there actually being sufficient iron stores. In other words, you can have a true iron deficiency anemia superimposed on an anemia of inflammation/chronic disease. I think it is important to talk to your doctor(s) about all of your test results and the pros and cons in your case given the GI bleed. While it is generally not ideal to give iron when there is an active infection, it seems that the results of studies regarding iron supplementation and infection risk are actually a bit muddy, and many have concluded that the risk-benefit ratio is likely to be specific to the individual context. I actually had anemia of inflammation and did not treat it (which was appropriate). I later had significant bleeding, developed clear IDA with low ferritin, and I have had iron supplementation. Basically, it seems that, most of the time, for people with chronic infections, it seems to make the most sense not to take iron for a mild anemia with normal ferritin. However, as the situation gets more complicated, the decisions get more complicated as well.

My understanding is that ferritin is the primary test used to differentiate a true iron deficiency from anemia of inflammation, but the results are not always clearly interpretable. Ferritin is a protein involved in iron storage. When it is low, it pretty clearly suggests that there are not sufficient stores of iron. Often, if the body is sequestering iron to keep it away from a pathogen (i.e., anemia of inflammation or anemia of chronic disease), ferritin will be normal or even elevated because there is stored iron, but iron levels are low because the body is playing keep away with the bacteria. That said, it remains a judgment call with normal ferritin levels because ferritin levels can be artifactually increased by some other factors without there actually being sufficient iron stores. In other words, you can have a true iron deficiency anemia superimposed on an anemia of inflammation/chronic disease. I think it is important to talk to your doctor(s) about all of your test results and the pros and cons in your case given the GI bleed. While it is generally not ideal to give iron when there is an active infection, it seems that the results of studies regarding iron supplementation and infection risk are actually a bit muddy, and many have concluded that the risk-benefit ratio is likely to be specific to the individual context. I actually had anemia of inflammation and did not treat it (which was appropriate). I later had significant bleeding, developed clear IDA with low ferritin, and I have had iron supplementation. Basically, it seems that, most of the time, for people with chronic infections, it seems to make the most sense not to take iron for a mild anemia with normal ferritin. However, as the situation gets more complicated, the decisions get more complicated as well.