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Fatigue and AnemiaFatigue and Anemia
          
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iron deficiency anemia and fatigue
Jun 14, 2000

Hi Dr.F.

I heard you speak in San Diego last year. Thank you for sharing your story with us and giving us useful honest information. Your talk was by far the best (and most entertaining) we've had. We are all hoping you will come back soon. My question relates to anemia caused by chronic HIV infection. My red blood cell count is beginning to slip out of the normal range and I'm really starting to feel run down and cranky. My doctor wants me to start taking iron supplements because my serum iron is low. My total iron binding capacity (TIBC) -- whatever that is -- is also low. In the notes I took during your talk I wrote down that iron deficiency anemia has low serum iron and an elevated TIBC. My doctor is not an HIV specialist and is reluctant to refer me to one. Should I take the iron or should I take that weekly injection you talked about? Thanks in advance for your reply. Please come back to San Diego soon.

B

Response from Dr. Frascino

Hello B,

I'm impressed you were taking such detailed notes during my talk! Here's the scoop on serum iron as it relates to iron deficiency anemia vs. anemia of chronic disease. This gets a bit technical and even doctors sometimes have difficulty distinguishing between these two entities. The blood serum iron test is low in both conditions. The total iron binding capacity is usually increased in iron deficiency anemia as opposed to anemia of chronic disease where it's normal or low. This value however is not reliable in distinguishing between these two conditions. We recommend measuring serum ferritin or bone marrow iron stores to get an accurate assessment of iron stores. Serum ferritin (iron stores) should be low in iron deficiency anemia. Iron stores in anemia of chronic disease are normal or elevated. Anemia of chronic disease is also associated with a blunted erythropoietin level for the degree of anemia. Bottom line —- check your serum ferritin and erythropoietin levels before starting any therapy. If your iron stores are elevated or normal and your erythropoietin level blunted, treatment with PROCRIT should be very effective for you. If the erythropoietin level is elevated appropriate to the degree of anemia and your serum ferritin is low, then iron supplementation would be the way to go. See I told you it was a bit confusing. Write back with your labs or have your physician contact me if you are still in doubt. With the correct diagnosis and treatment you should be feeling better very soon!

RJF


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