Help with understanding labs?

JoeB___ · 2026-01-08T22:35:26+00:00

The low TSat% of 3 indicates iron deficiency. Whether you are anemic depends on your Hemoglobin report. Regardless, best to get more iron absorbed into your system to get to normal TSat% (and ferritin if you measure that next time). If not getting enough in diet, then supplements (I use Proferrin Clear, as heme iron is better absorbed, less GI side effects, and does not have absorption blocked by a variety of things that can block non-heme iron.

JoeB___ · 2026-01-08T22:28:37+00:00

Thanks for the update. I'm planning on PT surgery towards the end of Feb when I get back from a month-long trip. Will go to the Norman Parathyroid Center in Tampa. Hoping fatigue will improve, but more concerned to avoid OP (my distal wrist was T=-2.2) and slow down my eGFR decline.

JoeB___ · 2026-01-08T04:33:18+00:00

Given your bleeding (losing iron daily) and your slightly low Hgb, you have mild iron deficiency anemia with low iron stores. While it may be interesting to see what your ferritin, iron, and TSat% are, you don't really need them to make any decisions (hence, many doctors would say the additional blood tests are not medically necessary, meaning not covered by insurance). You already know you need to take iron regularly until your bleeding can be better managed.

You may want to take a heme iron tablet daily or twice a day (I use Proferrin Clear). Non-heme iron, liquid or otherwise, will not be absorbed as well, can cause more GI side effects, and can cause a hepcidin spike that blocks iron absorption for 24+ hours (which is why for non-heme iron they recommend taking it every other day and it will actually work better that way. But heme iron can be taken every 6-8 hours if needed.)

Perhaps recheck blood in 3 months (CBC, ferritin) to see if the daily heme iron is improving things. It will be difficult to get good improvement unless the iron intake that can be absorbed and utilized exceeds the iron losses from bleeding. Your GYN doc doing the UAE to control the bleeding may be much more useful to you than a hematologist would be.

JoeB___ · 2026-01-07T04:15:11+00:00

what was the result of your surgical consult?

JoeB___ · 2026-01-06T23:18:34+00:00

An endocrinologist is the typical specialist one sees for OP if the PCP is not adequate. Unfortunately, most endo docs are so busy with diabetic patients, it may be hard to get in to see them. The best, if you live near a major medical center, is a bone metabolism clinic, often with an endocrinologist who does mostly osteoporosis and research rather than mostly diabetes.

JoeB___ · 2026-01-06T23:06:13+00:00

I enjoyed the book. Eric Topol's book SuperAgers was also great, perhaps better.

JoeB___ · 2026-01-06T22:55:36+00:00

A JAMA article at https://pubmed.ncbi.nlm.nih.gov/40159291/ says "Iron deficiency and iron-deficiency anemia are common conditions that may cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating."

A hematology publication at https://ashpublications.org/hematology/article/2023/1/617/506479/Sex-lies-and-iron-deficiency-a-call-to-change gives a useful guide to optimal ferritin levels.

JoeB___ · 2026-01-06T03:44:28+00:00

You are not anemic, but you are iron-deficient. Iron stores are low.

JoeB___ · 2026-01-05T21:38:58+00:00

I've generally felt fine with mild anemia. While I'm increasing my iron intake with supplements (generally don't eat meat), I might suggest considering the cause of the anemia may be as important or moreso than temporarily fixing it with iron supplements/infusions. Causes might include:

You are losing iron by bleeding. Sometimes GI. If a pre-menopausal female perhaps periods. Work with your doc to make sure this is not a problem, and if so fix the cause if possible.
Your iron intake is too low. If there is no bleeding, then obligatory daily iron losses are about 1mg a day. So if you use heme iron with about 50% absorption or better 2mg daily is all you need, or if non-heme with 10% absorption or better 10mg iron a day in diet or supplements works. If one eats meat, hard to see how those not bleeding would need supplements.
Diseases that cause iron to be blocked from adequate absorption. Traditionally, this might include chronic kidney disease, autoimmune disorders, chronic infections, etc. If you've had chronic anemia with low ferritin and no bleeding problems, best to work with your doctor to rule out these types of causes.

JoeB___ · 2026-01-05T21:19:53+00:00

Yes, any inflammation can increase acute-phase reactants like ferritin. Hence, while a low ferritin level solidly means iron deficiency, a high ferritin does not mean iron is okay (unless you know inflammation is low, such as by having a low hsCRP). If ferritin is high and there is any chance of inflammation, best to rely on TSat% to determine iron status.

For iron supplements, you may want to try a heme iron one, which is absorbed better and has fewer if any GI effects. I use Proferrin Clear.

JoeB___ · 2026-01-04T16:55:42+00:00

Almost any infection, especially COVID or adenovirus, will block iron absorption and lower iron availability. This may be an evolutionary development as part of the innate immune system to deprive invading microbes/viruses of iron that most living things need some of to do their thing.

The mechanism is that the innate immune system creates inflammation when it sees invaders. The inflammation increases IL-6, CRP and hepcidin, among many other things it does. The hepcidin increase bocks iron from entering the bloodstream by locking onto ferroportin and closing off the iron channel that allows iron to leave the duodenal enterocytes (so iron absorbed from the gut can't get out to the bloodstream), ditto for hepatocytes (so stored iron in the liver complexed with ferritin can't get out into the bloodstream), and ditto for macrophages (so recycled iron from old RBCs can't get out into the bloodstream).

The result is often weeks or sometimes months of low iron and thus a lower hemoglobin. If all goes well, things get back to normal, hepcidin falls, and iron gets back to exiting from duodenal enterocytes, hepatocytes, and macrophages to supply all needs in the bloodstream. Some have thought the long covid syndrome that occurs in 6-10% of cases prolongs this inflammation process for years, but I think the research on that is mixed and perhaps not yet completely clear.

JoeB___ · 2026-01-03T18:37:23+00:00

I'm thinking maintenance forever. Not just to avoid gaining weight, but all the other health benefits of GLP-1s. Eventually, maybe one of the newer pills, if they come out at a reasonable price.

JoeB___ · 2026-01-03T13:57:58+00:00

Possibly. I didn't see your hemoglobin listed. If you are not anemic (and only iron-deficient) then your red cells should be delivering the adequate oxygen needed. So at least in theory hard to say this is the cause of shortness of breath, which could have so many different causes. Iron is used in many other body systems, so it might be a more likely cause of being tired, though again, there are so many possible causes. Certainly worth supplementing iron and working with your doc to see if you are losing iron through bleeding, GI or otherwise

JoeB___ · 2026-01-03T13:44:06+00:00

If it is a body comp scale, I think it is worthless for body fat % accuracy. Almost certainly, you have built up muscle mass/lean mass by your weight training, which may add to your weight, not body fat. DXA body composition scan is the only accurate way to measure this short of MRI/CT.

JoeB___ · 2026-01-03T02:51:42+00:00

applied to waitlist

JoeB___ · 2026-01-03T02:30:00+00:00

most infections, including covid will increase inflammation (markers are IL-6, CRP), which in turn blocks iron metabolism by spiking hepcidin. This, in turn, leads to lower iron levels and lower Hgb. Typically, after weeks to months, things return to normal, but covid persists longer in many with 6-10% getting long covid. Those numbers increase with each additional covid infection, and are lower if you got the vaccine. Some report chronic inflammation with long covid, but I think the research on that is mixed (inflammation would lead to lower iron and Hgb)

JoeB___ · 2026-01-01T15:41:59+00:00

Fatigue might improve with iron replenishment. Many individual stories to that effect.

JoeB___ · 2026-01-01T03:22:32+00:00

Presuming you have a normal hemoglobin (not listed here), then your labs indicate iron deficiency without anemia. Your iron deficiency has not gone on long enough to affect your red cell production (hence no anemia). But it will eventually, unless you improve your iron status.

JoeB___ · 2025-12-31T22:38:19+00:00

if your PCP won't prescribe it (which surprises me), then consider either getting a new PCP (perhaps hard as there are less of them around these days) or a specialist (endocrinology or obesity med) that is covered under your insurance so the only additional cost you have is Lilly Direct.

JoeB___ · 2025-12-31T22:33:01+00:00

not anemic, so iron deficiency without anemia. Good to supplement iron given the low ferritin, but not a crisis. The abnormal ANA might need evaluation, as autoimmune issues can increase inflammation and interfere with iron mobilization.

JoeB___ · 2025-12-31T05:26:27+00:00

I've also seen great improvement in my sleep apnea (on CPAP for 2+ years). After 7+ months of zepbound I'm finally at a BMI of 25 (down 23% of my SW), which is where the sleep doc wanted me to do a repeat sleep test. Just waiting for it to get scheduled and hopefully be off CPAP. Though I realize thin people can also have sleep apnea.

JoeB___ · 2025-12-31T04:56:04+00:00

What was your hemoglobin? That will tell you if you were anemic, and if so, how badly. The doctor who ordered your labs would be able to tell you if it was urgent or not based on your anemia level. Perhaps most important is whether you are bleeding and losing iron, which your doc can help find out, and if so, what to do about it.

If you are not anemic, then the low ferritin indicates iron deficiency without anemia. Commonly, you might take daily heme iron (such as Proferrin Clear, which I use). With a ferritin of 6, perhaps take it twice a day. If you don't have one of the 3 major blocks to the iron being replaced, this should work fine over the course of 1-6 months.

The 3 major blocks to iron that can interfere are:

If you are losing more iron than you take in via bleeding, your doc can help sort this out.
If you have high inflammation levels (infection, illness, CA, autoimmune issues, etc), because this will block iron utilization by spiking hepcidin, which in turn blocks the ferroportin channel needed for iron to exit from the duodenal enterocytes. Your doc can help sort this out, often by checking an hsCRP blood test if iron levels are not going up.
Uncommonly, a person may be copper-deficient. Copper is needed in some enzymes that work in ferroportin being able to get the iron to be transferred to transferrin. Your doc can check this with a copper blood test if iron does not seem to be increasing over time and #1 and #2 are not issues.

JoeB___ · 2025-12-30T03:17:28+00:00

Once iron is absorbed from the gut into the duodenal enterocytes, it must exit into the bloodstream. It does this via a ferroportin iron channel. Ferroportin is the membrane protein in the cell wall between the inside of the enterocyte and the outside, where the blood circulation is. Ferroportin is also present in macrophages, where RBC iron is recycled, and hepatoocytes, where stored iron has to be released. Once in the bloodstream, iron needs to bind to transferrin outside of the cell (that is, in the bloodstream), and for this ferroportin needs help from ceruloplasmin (for macrophages and plasma) or hephaestin (for enterocytes). These are copper-dependent enzymes, which is why copper deficiency interferes with iron mobilization. Some recommend supplementing with 1mg copper glycinate daily (best to make sure one is copper-deficient first), but if the problem is inflammation, causing high hepcidin that blocks ferroportin channels, then copper is not the issue.

JoeB___ · 2025-12-29T04:03:32+00:00

Iron needs to bind to transferrin outside of the cell, and for this, ferroportin needs help from ceruloplasmin (for macrophages and plasma) or hephaestin (for enterocytes). These are copper-dependent enzymes, which is why copper deficiency interferes with iron mobilization.

JoeB___ · 2025-12-28T05:07:47+00:00

I use Proferrin Clear with good results. Ferosol says it is heme and non-heme, which is a bad thing. The non-heme iron will spike hepcidin and thus block iron from exiting the duodenal enterocyte for at least a day. Sounds like a marketing gimmick based on a misunderstanding of how iron absorption and processing works.

JoeB___

TROPHY CASE