Might my anemia and lowered hemoglobin be related to MAC?

Thank you both for your concern and suggestions! For me, the onset clearly coincided with the severe exacerbation/hospitalization that led to the diagnosis. The anemia did persist after the sepsis resolved, but, since the hospitalization, it has been mainly mild, with only one transient drop into moderate. My ID doctor actually was the first to mention the connection in passing as he looked at my labs, and I looked into it a bit to see what the mechanism might be (particularly since it predated my first episodes of hemoptysis). It appears that the anemia that can be seen with MAC is not specific to it, but likely an instance of the broader category of "anemia of inflammation" (AKA "anemia of critical illness", if acute, and "anemia of chronic disease" , when chronic). It is seen in association with many inflammatory conditions including acute and chronic infections and autoimmune disease. It is thought to be driven by an immune response, which results in storage or sequestration of iron. This keeps the iron away from a pathogen (MAC apparently likes iron), which is a useful response acutely, but chronically, it also keeps it (quite literally) out of circulation. Anyway, at least for now, the anemia is fortunately not bad enough to worry about. It is just a part of my new normal (and actually less disconcerting than recently discovering I have E. coli in my lungs, which was just weird).

Salynn, Thank you for this helpful explanation about anemia. I have a low red blood cell count. (I have been on the Big Three antibiotics for 2 months following a MAC diagnosis.) Back in the Spring I had several iron infusions because of anemia and I've been wondering why these infusions didn't do more to elevate the red blood count. But your explanation makes a lot of sense. My red blood count isn't low enough to alarm my doctor, but she wants to check it again in 6-8 weeks.

Some people take Lactoferrin instead of iron for low hemoglobin. There is a liquid iron called Floradex, which is very good for anemia.

Strangely, my hemoglobin levels are fine, but my red blood cells are low. My doctor told me not to take iron. I asked him why red blood cells were low and he said "It's complicated." I should research it.
Take care

My pulmonologist told me that iron binds to Pseudomonas. Zinc also does. I am not sure what that means exactly or if taking either could make things worse. But I got the impression he was saying if you need iron or zinc you might take them but otherwise not to? Perhaps it is similar with MAC? I do not take Zinc often but when I do it usually seems helpful.

Irenea8. Your post caught my attention and wondering what does this all mean. I've taken Zinc for years to help my immune system. I was first diagnosed with MAC and Pseudomonas five years ago. I had a GI bleed the end of last November and am now anemic. The iron pills did not help and I'm set for a iron infusion this coming Wednesday. Glad to see our lung problems are getting more research and interest.

Do you still have Pseudomonas? Or was it cleared? Mine is chronic so i have it all the time. My pulmonologist also said in that same conversation that an iron infusion would be risky for me due to the Pseudomonas. If you do have chronic Pseudomonas can you check this with your pulmonologist? Mine specializes in Bronchiectasis and CF and is in the specialty pulmonary department at the University of Iowa Hospitals and Clinics. Also some iron pills may absorb better than others or taken with Vit C.