Could vitamin C intake cause high ferritin level in routine blood test?
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Hello, I'm a 42 year old male and recently had a routine blood test that showed my ferritin high at 736 ng/mL, ALT at 53 IU/L, and total bilirubin at 26 umol/L. A year ago, my ALT was normal at 34 (no ferritin test was taken then). As part of investigating IBS, 4 months ago I had a CT scan of my abdomen and pelvis that was all normal, colonoscopy normal too. A year ago, an ultrasound of the same region was also all normal. I have been taking a multivitamin with 14mg of iron each day with breakfast. I also was taking 500mg of vitamin C with each of my 3 meals per day. My doctor recommended stopping the vitamins and retesting in a month. I was taking the vitamins on my own advice, there was no medical reason for taking them. Could that vitamin intake really lead to such a high ferritin level? There's no history of hemochromatosis in my family and my thyroid test TSH was normal at 2.07 mU/L. I do not drink much alcohol and do not smoke. Thank you.
Posted Fri, 10 Jan 2014 in Blood Disorders
Answered by Dr. Robert Galamaga 6 hours later
Brief Answer: considerations Detailed Answer: Hello and thank you for sending the question. I don't think the vitamins had anything to do with your elevated ferritin level. I agree that a ferritin level of 736 is elevated but there are many things which can cause this. What is important is to look at the rest of your iron index values. This includes iron level, total iron binding capacity, transferrin level as well as the ferritin level. These can be used to calculate a saturation level of your transferrin. If this is significantly elevated this might indicate a situation of hemachromatosis. In addition there are other things which can cause elevation of ferritin. This includes illness or possibly some type of autoimmune disorder. I have to say that elevated ferritin in a single test is not sensitive or specific for hemochromatosis. I would recommend that you obtain a follow-up value and obtain this value while fasting.if it is still elevated you might consider consultation with a local gastroenterologist. If the ferritin level remains elevated it would be reasonable to have a liver biopsy performed or possibly obtain an MRI of the liver. The MRI helps to delineate whether there is significant amount of iron sequestered in the liver. This is a problem in patients who have hemochromatosis. Thank you again for sending her question. I appreciate the fact that you are sharing your health concerns with us. If you have additional concerns we would be happy to help you with those in the future. Dr. G
Follow-up: Could vitamin C intake cause high ferritin level in routine blood test? 29 hours later
Dr. G, Thank you for your answer. I took my test having only eaten some blueberries in the morning with some water. I did take other iron tests. There were as follows: Serum Iron 17.9 umol/L Unsaturated Iron Bg. Capacity 40.3 umol/L Iron Binding Saturation % 30.0% Other things tested: ESR 2 mm/Hour MCH 32.3 pg MCHC 354 g/L The blood test was on 40 items, all else was normal. I am a bit overweight...215 lbs on 5'6", although I have a muscular build, so it's not as heavy as being pure fat. The only other ailment I have is plantar fasciitis the last few months in my left foot. Do the other test indications suggest anything? Does the low/normal ESR rule anything out? hemachromatosis? Do you think this could be a case of fatty liver? Would the CT scan of my abdomen four months ago mean anything given that they didn't show anything abnormal about my liver? A few days after the test, I did retake the ferritin test and it was similarly high, don't know the exact result. Thanks again for your help. -XXXX
Answered by Dr. Robert Galamaga 5 hours later
Brief Answer: follow-up Detailed Answer: thanks again for the additional information. There is actually a genetic test that can be requested for hemochromatosis. I still somewhat doubt that you have this but your doctor can request this special blood test. It might also be reasonable for you to visit with a gastroenterologist to review the findings of your laboratory studies. I think a fasting blood test as I mentioned earlier where you do not eat for at least 12 hours would be a reasonable test to perform in about 2-3 weeks. The sedimentation rate does not rule anything out unfortunately. It is somewhat of a nonspecific test for inflammation. Fatty liver is a possibility but would have probably showed on the CAT scan. An ultrasound of the liver might actually show that as well. I recommend that you take a look at your height and weight and consider an exercise regimen to minimize total body fat and maximize excellent diet and regular aerobic physical activity. If the CAT scan 4 months ago was negative I would doubt anything new which show up. This does not however evaluate iron in the liver. For this and MRI would be needed. Ultimately a biopsy would allow a pathologist to evaluate the tissue under a microscope and use special stains to see if there is actually elevated iron in your system. I would recommend that you sit down with your doctor and put together a plan for appropriate follow-up and testing and explanation of why all these tests are being requested. Thanks again for sending your question. Dr. G
Follow-up: Could vitamin C intake cause high ferritin level in routine blood test? 21 hours later
Dr. G, Thanks again for your reply. I am going to retake the test in a few weeks and will fast and stop taking any vitamins or supplements. May I ask, are there any tests that I should ask my doctor to do in particular? I was thinking of asking for a CRP test besides the ESR test. Is there anything else you would make sure he tests for at the next blood test? Does the CRP test show anything the ESR won't? Also, you said that you doubt that I have hemochromatosis, I assume that's because my saturation is normal? Or is there another reason you think that? In terms of doing an MRI, will that show things better than the CT with contrast that I took a few months ago in terms of liver disease etc? I am in the process of improving my diet...eating less and more healthy...I have lost 17 lbs in the past few 6 weeks or so. When I fast for the next blood test, can I drink water or absolutely nothing for 12 hours? Thanks Doc, XXXX
Answered by Dr. Robert Galamaga 56 minutes later
Brief Answer: Followup Detailed Answer: water is fine to drink before the next test. MRI will just really identify if the liver does have increased amounts of iron deposition. CRP is non specific and not helpful in my opinion. one test at a time. sometimes we can get caught up and order lots and lots of tests which can be more confusing in this setting. yes - saturation being normal casts some doubt on the hemochromatosis idea but is still worth a followup. If the next test is abnormal - would consider HFE gene testing which would identify if you carry a hemochromatosis genetic alteration. have a great day! dr G