Help with understanding Bloods

[crush99]

Every thing is in line and acceptable outside of what I have attached

I'm 35, competed a lot in past. Haven't run beyond hrt in sometime. Trying to hrt and start healthy, ....

Currently on 280mg/ wk of test script
1.8ius gh Seros
500-1000mg metformin/day script
25mcg t3 script
50mcg t4 script
2-4ml a day of Syntheselen
2-4ml a day of Synthetine
1ml 3x a week of Synthelamin
4ml a day of Synthergine ( perfect liver values thanks to this)

I do bloods about every 90-120 days. Past 2 reports have show. Low ferritin levels, I do doable donations of blood every 120 days as well to keep Hemocrit and hemoglobin in check. Would that lower the ferritin that much? I started taking an iron supplement of 65mg a day. Would this cause the off RBC width readings ? I have just never had a high marker on this line item so I don't fully understand if there is a need of concern.

 

[crush99]

Not sure if I need to add back in armidix? I have a script but came off when I went I dropped by estradiol below 10 while on hrt, now it's at 37. I was taking it daily when it was sub 10

 

[crush99]

Also at this test dosage my Free is about 36-39 ng/dl and my total is 840-1000 ng/dl.

 

[gotgame]

Looks good to me.

Try to get that HDL up more.


Not worried about RDW. The width ( size variability) can go up with frequent donations which makes sense as your body is trying to make more. I also see it all the time for guys who are on cycle or on higher levels of TRT which also makes sense given how Test affects rbc production.

There is also the chance that maybe you are a lil deficient in a few things like B vitamins which can do it but probably unlikely as I think one of your supplments has it in it and you are probably eating a well balanced diet. Although I will note that you are taking metformin which can mess with b12.

I dont think you need to take that much iron, its not like you are losing it anywhere.

You attribute your liver values to a supplement you are taking....why? Why would you except your liver values to be anything other then perfect without it?

 

[crush99]

Thanks for the response

Ferritin levels have been sub 20 the last 2-3 panels. Might that also be caused by the donations? I'm not sure but that's why she got me on the iron protocol.

We watch the B vit cause of the metformin, but since I supplement it I'm usually 1200-1500 pg/ml more than enough

My ast and alt always run mildly elevated , usually around 40/60. Unless I'm taking the Synthergine

I take Fish, Flax, and loads of other supplements for cholesterol and general health. What else do u like for HDL?

 

[Stewie]

Thanks for the response

Ferritin levels have been sub 20 the last 2-3 panels. Might that also be caused by the donations? I'm not sure but that's why she got me on the iron protocol.

We watch the B vit cause of the metformin, but since I supplement it I'm usually 1200-1500 pg/ml more than enough

My ast and alt always run mildly elevated , usually around 40/60. Unless I'm taking the Synthergine

I take Fish, Flax, and loads of other supplements for cholesterol and general health. What else do u like for HDL?

The dual rise with both indices of RDW--CV and SD, is an indication that you're responding to your iron therapy.

I would continue to treat your iron deficiency, as a ferritin level of 20ng/ml is on the lower end of normal... Most lab's are around 20–300 ng/ml.

Keep in mind. With each 500ml of blood loss we lose upwards of 250mg of iron, and lower serum ferritin by 30-50ng/ml.

 

[maldorf]

The dual rise with both indices of RDW--CV and SD, is an indication that you're responding to your iron therapy.

I would continue to treat your iron deficiency, as a ferritin level of 20ng/ml is on the lower end of normal... Most lab's are around 20–300 ng/ml.

Keep in mind. With each 500ml of blood loss we lose upwards of 250mg of iron, and lower serum ferritin by 30-50ng/ml.

Definitely why your Iron is a bit low. My hematologist had me stop taking my multi vitamin because it had iron in it because he wants to keep my Iron level down. Eventually after many phlebotomies and my stopping that multi I was able to get my iron down low enough to where my body tremendously slowed down the production of RBCs. He likes my hemoglobin to be 15 or lower. At first I had to go in once a month and get 500ml of blood out, but now I am able to go in once every 2 or 3 months because my iron is lower now.

 

[Stewie]

Definitely why your Iron is a bit low. My hematologist had me stop taking my multi vitamin because it had iron in it because he wants to keep my Iron level down. Eventually after many phlebotomies and my stopping that multi I was able to get my iron down low enough to where my body tremendously slowed down the production of RBCs. He likes my hemoglobin to be 15 or lower. At first I had to go in once a month and get 500ml of blood out, but now I am able to go in once every 2 or 3 months because my iron is lower now.

I wonder if you fit into a different criteria, due to your MI, invoking more damage to your heart?

I'm speculating that your cardiologist is thinking that the build up of circulating iron (and or stored iron [ferritin])may impose oxidative stress on your myocardium?

I'm contrast, iron deficiency with anemia can have injurious effects on the heart. I'm not sure how iron deficiency without anemia would pan out on heart health? I would suspect relatively the same?

Although, in your case Maldorf, you're not anemic.

Do you know any of your iron parameters: TIBC or UIBC, Saturation %, Transferrin, Serum iron or Ferritin?

 

[tenny]

these bloods look damn near perfect man.....


i wouldn't worry AT ALL.

 

[crush99]

Thanks for the input guys! Much appreciated

Do u think I should back off the double red cel donations until the Ferrtin levels rebound to proper #s. I never had the low Ferrtin until about the time I started doubles.

 

[Stewie]

As aforementioned, with each 500ml of blood loss we lose upwards of 250mg of iron. That's a typical blood donation-500ml. With a double red blood cell phelbotomy, we'll lose twice as much iron per 2 units of blood. ~approximately--500ml of iron loss. Again, with each single unit of blood loss we lower our ferritin by 30-50ng/ml. You can easily tank your ferritin levels rather quickly doing a double RBC.

To keep this concise without overbearing details. The average sized male has approximately 4-6 grams of iron in circulation and storage form of iron, ferritin. Simple math if you configure the numbers.

Our bodies are designed to uptake only so much iron, hence Hepcidin. Hepcidin is a iron regulatory peptide hormone. Aside from the regulatory roles of Hepcidin, we'll absorb only so much iron per meal setting. Several foods and drinks can inhibit iron absorption; in contrast several foods and drinks can help absorb iron uptake.

Iron is very important for several actions in our bodies. Such as the biosynthesis of oxygen transport, DNA synthesis, neurotransmitters synthesis, such as dopamine, hormone synthesis, ect.

We have to keep in mind with doing too many back-to-back phlebotomies, we up the chances of becoming iron deficient. This is especially true with doing multiple double red cell donation.

With iron deficiency you are at risk for setting the stage for Afib, increased platelet aggregation causing platelets to become more sticky, increasing the possibility of stroke. You are also at an increased risk of infections, reduced exercise capacity, insomnia, long-term iron deficiency increases your risk of cardiomyopathy, peripheral neuropathy. There's many other pathophysiologcal fallouts from iron deficiency with or without anemia

To me it's very imperative that we monitor our iron status on a regular basis if we are doing multiple phlebotomies throughout a year.

All in all, if you are having ongoing issue with increased RBC-HH (hemoglobin-hematocrit) in conjunction with testosterone replacement or a cycle. I would suggest ruling out sleep apnea.

Intermittent apneas or hypoxia (lack of oxygen) can stimulate red blood cell production. With severe case of uncontrolled sleep apnea, this will cause hemoglobin cells to become desaturated of oxygen or what's termed deoxyhemoglobin. In other words, your hemoglobin mass will increase in response to the demand of O2. Therefore require you to have therapeutic phelbotomies. If in the event that you may have tanked your iron-ferritin levels, this can lead to Iron deficiency. In which can increase tongue size (swelling), therefore induce or exacerbate pre-existing OSA.

This would be a caveat of doing too many routine phlebotomies, invoking iron deficiency.

So no, I would not do any more double RBC phelbotomies until you regain an optimal ferritin level. Even then, doing single donations can hinder this.

Just keep a watchful eye on your hemoglobin-hematocrit (H-H) levels. It can be a double edge sword trying to balance our iron-ferritin levels with an ongoing elevated.

 

[Stewie]

As aforementioned, with each 500ml of blood loss we lose upwards of 250mg of iron. That's a typical blood donation-500ml. With a double red blood cell phelbotomy, we'll lose twice as much iron per 2 units of blood. ~approximately--500ml of iron loss. Again, with each single unit of blood loss we lower our ferritin by 30-50ng/ml. You can easily tank your ferritin levels rather quickly doing a double RBC.

To keep this concise without overbearing details. The average sized male has approximately 4-6 grams of iron in circulation and storage form of iron, ferritin. Simple math if you configure the numbers.

Our bodies are designed to uptake only so much iron, hence Hepcidin. Hepcidin is a iron regulatory peptide hormone. Aside from the regulatory roles of Hepcidin, we'll absorb only so much iron per meal setting. Several foods and drinks can inhibit iron absorption; in contrast several foods and drinks can help absorb iron uptake.

Iron is very important for several actions in our bodies. Such as the biosynthesis of oxygen transport, DNA synthesis, neurotransmitters synthesis, such as dopamine, hormone synthesis, ect.

We have to keep in mind with doing too many back-to-back phlebotomies, we up the chances of becoming iron deficient. This is especially true with doing multiple double red cell donation.

With iron deficiency you are at risk for setting the stage for Afib, increased platelet aggregation causing platelets to become more sticky, increasing the possibility of stroke. You are also at an increased risk of infections, reduced exercise capacity, insomnia, long-term iron deficiency increases your risk of cardiomyopathy, peripheral neuropathy. There's many other pathophysiologcal fallouts from iron deficiency with or without anemia

To me it's very imperative that we monitor our iron status on a regular basis if we are doing multiple phlebotomies throughout a year.

All in all, if you are having ongoing issue with increased RBC-HH (hemoglobin-hematocrit) in conjunction with testosterone replacement or a cycle. I would suggest ruling out sleep apnea.

Intermittent apneas or hypoxia (lack of oxygen) can stimulate red blood cell production. With severe case of uncontrolled sleep apnea, this will cause hemoglobin cells to become desaturated of oxygen or what's termed deoxyhemoglobin. In other words, your hemoglobin mass will increase in response to the demand of O2. Therefore require you to have therapeutic phelbotomies. If in the event that you may have tanked your iron-ferritin levels, this can lead to Iron deficiency. In which can increase tongue size (swelling), therefore induce or exacerbate pre-existing OSA.

This would be a caveat of doing too many routine phlebotomies, invoking iron deficiency.

So no, I would not do any more double RBC phelbotomies until you regain an optimal ferritin level. Even then, doing single donations can hinder this.

Just keep a watchful eye on your hemoglobin-hematocrit (H-H) levels. It can be a double edge sword trying to balance our iron-ferritin levels with an ongoing elevated H-H.

Edited: bold

 

[maldorf]

I wonder if you fit into a different criteria, due to your MI, invoking more damage to your heart?

I'm speculating that your cardiologist is thinking that the build up of circulating iron (and or stored iron [ferritin])may impose oxidative stress on your myocardium?

I'm contrast, iron deficiency with anemia can have injurious effects on the heart. I'm not sure how iron deficiency without anemia would pan out on heart health? I would suspect relatively the same?

Although, in your case Maldorf, you're not anemic.

Do you know any of your iron parameters: TIBC or UIBC, Saturation %, Transferrin, Serum iron or Ferritin?

It is not the cardiologist that is overseeing any of the but rather my hematologist. I think keeping the iron down is being done in order to slow down the hemoglobin production and for no other reason. Nobody mentioned the oxidation effect. All I know is that he said once he got me to where I am borderline iron deficient that was where I need to be to slow things down and he was right. I have not felt any negative effects from this and it allows me to just get phlebotomies on a 2 or 3 months basis. About once every 6 months he takes iron levels but I never see the results and he hasn't contacted me about any concerns. So far everything is going well for me.

I asked my cardiologist why my hemoglobin builds up so high and if it might be my body's way of compensating for a low EF and he said it may be. I don't know if there have been any studies on that. The doctors seem to blame it mostly on my HRT and I think that is probably what is doing it. Even just 100 mg/wk affects me. I remember when I was cruising on just 250 mg/wk test before my heart attack and my hemoglobin built up to 60!

 

[maldorf]

With iron deficiency you are at risk for setting the stage for Afib, increased platelet aggregation causing platelets to become more sticky, increasing the possibility of stroke.
.

I am glad that you mention this because I did some research online and saw the evidence for this. The reason I researched it was because right before I had my blood clot/heart attack I had done 2 phlebotomies spaced 7 days apart. I saw where doctors can do that in occasions where hemoglobin is as high as mine was at 60 so I figured it was ok. I did my own. Looking back now I wish I had just gone in to a new doctor's office and spilled the beans about using steroids and needing a phlebotomy so that a professional could oversee things. Instead, I chose to take care of things myself because the blood bank wouldn't take mine since my hemoglobin was so high. My doctor was an ass and just told me to stop using, and he did not offer to do a phlebotomy. I should have found a new doctor.

We also had a member die on here from what I remember being a pulmonary embolism that arose from a DVT, and he was doing his own phlebotomies. Now I tell nobody to do their own. Saving money or keeping things secret is not a good reason to take such a risk.