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What causes high ferritin and low hematocrit levels?

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Posted on Thu, 19 May 2016
Question: What would cause high ferritin levels (900) and low hematocrit (31.9), low hemoglobin (10.5), low RBC (3.49) and giant platelets?
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Answered by Dr. Anil Parth Desai (2 hours later)
Brief Answer:
Hi I would recommend the following.

Detailed Answer:
Dear Sir,

Thank you for your query on HCM.
High ferritin and giant platelets can be seen in many common conditions including recent systemic infections as trivial as recent viral infections like flu or cold.
High ferritin is also seen in other conditions where iron stores are increased due to repeated rbc destruction or increased iron absorption.

Low hemoglobin ( and low hematocrit) is an important finding and it requires proper work up for accurate diagnosis and management. Can you please upload your complete blood report and any other relevant lab reports so that I can analyse and give you a complete detailed answer and also let you know the next steps needed to be taken. you can also send them to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai'.

Awaiting your reply with reports.
Let me know if you have any more questions or concerns sir.
Wish you all the best.
Sincerely,
Dr Parth Desai.
Above answer was peer-reviewed by : Dr. Deepak
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Follow up: Dr. Anil Parth Desai (14 hours later)
Not sure exactly what labs were uploaded, but the most recent is the March 16, 2016. It was noted before that "giant platelets" were seen at the hematology clinic at Stanford University. I recently had an ER visit to a small ER where this type of platelet was also noted. If you are viewing a lab report from Mountain Communities Healthcare District, those labs were drawn after several days of diarrhea which has since resolved. I have been told by a nephrologist at Stanford that I have mild kidney disease and we are in a "wait and see" mode on the hematology with repeat tests. I am very curious as to what could cause such high ferritin values in the presence of low rbc, hematocrit, etc. The kidney issues don't seem to be severe enough to cause the hematology issues. I searching I can find plenty on low ferritin and low hematocrit, but not the opposite. Thank you for your attention
doctor
Answered by Dr. Anil Parth Desai (1 hour later)
Brief Answer:
Hi I would recommend the following.

Detailed Answer:
Dear Sir,

Thank you for your reply with results.

High ferritin and low hematocrit classically indicates ineffective red cell production which can be seen in a group of hematological condition known as myelodysplastic syndrome. Giant platelets can also be occasionally seen. However, we also need to rule other causes out such as anemia of chronic diseases, or that associated with renal diseases.

1)Have you had any chronic illness in the past such as infections of any body organ or chronic joint aches?

2) Also since your eGFR value is less than 40 in the latest report, has the nephrologist or doctor told about what is the cause of chronic renal disease. Although ferritin is not that high in anemia associated with chronic renal diseases but it can be an added component to your problems.

3) I would recommend the following tests if not already done to get to an accurate diagnosis-
(a) Stool for fecal occult blood to rule out rectal bleeding (which is a very common source of bleeding in adults although serum ferritin is usually not high but we need to rule this condition out).

(b) Erythrocyte sedimentation rate and CRP to see for signs of chronic inflammation and also a iron studies to look for serum iron, transferrin saturation levels and Soluble transferrin receptor levels.

(c) Lastly a bone marrow aspirate and biopsy may be needed to look for signs of myelodysplastic syndrome. This is an invasive procedure but may be needed in your case to rule out myelodysplastic syndrome.

I hope this helps.
Let me know if you have any more questions or concerns sir.
Wish you all the best.
Sincerely,
Dr Parth Desai

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Anil Parth Desai (1 hour later)
I saw my nephrologist 2 days ago and she characterized my renal disease as "mild" and probably caused by high BP over years which is now very well controlled with meds and deliberate weight loss (I have been overweight for many years). GI bleeding has been mentioned..my last colonoscopy was 2 or 3 yrs ago with benign polyps noted. I have had no chronic illnesses. A CRP was done many years ago which was normal. The eGFR value on the most recent report was noted, but the nephrologist felt that I had not completely recovered from the severe diarrhea that I had, which had only resolved about 3 days before this doctor's visit. My biggest confusion was the high iron levels combined with the low hematocrit. It seemed counter intuitive. I will purchase an occult blood stool test and proceed to colonoscopy when I return from my month long overseas trip. Any other thoughts?
doctor
Answered by Dr. Anil Parth Desai (3 minutes later)
Brief Answer:
Hi I would recommend the following.

Detailed Answer:
Dear Sir,

Thank you for your reply. I think your plan seems fine.

My advice would be to repeat eGFR and hemogram after the trip and if the hemoglobin or platelets have fallen then to get a bone marrow aspirate and biopsy done to rule out myelodysplastic syndrome.

Serum ferritin being high with anemia is counter intuitive but it is seen in certain conditions as I previously mentioned and also the fact that ferritin is a acute phase,protein makes it elevated in recent illness. This makes underlying diagnosis more difficult to catch.

I hope this helps.

Let me know if you have any more questions sir.

Do let me know about followup on your health.

Wish you all the very best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Anil Parth Desai

Pathologist and Microbiologist

Practicing since :2009

Answered : 593 Questions

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What causes high ferritin and low hematocrit levels?

Brief Answer: Hi I would recommend the following. Detailed Answer: Dear Sir, Thank you for your query on HCM. High ferritin and giant platelets can be seen in many common conditions including recent systemic infections as trivial as recent viral infections like flu or cold. High ferritin is also seen in other conditions where iron stores are increased due to repeated rbc destruction or increased iron absorption. Low hemoglobin ( and low hematocrit) is an important finding and it requires proper work up for accurate diagnosis and management. Can you please upload your complete blood report and any other relevant lab reports so that I can analyse and give you a complete detailed answer and also let you know the next steps needed to be taken. you can also send them to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai'. Awaiting your reply with reports. Let me know if you have any more questions or concerns sir. Wish you all the best. Sincerely, Dr Parth Desai.