CSF Ferritin predicts cognitive decline in E4s

[simonh01]

Slacker, 200 points drop per 500ml? You mean 20? How quickly does it drop?
Jafa, I'm feeling fine, how you feeling?

Yes he meant 20, you don't get a 200 drop with each phlebotomy although some people do report a drop quite quickly from high numbers like 1200. You have to keep in mind that ferritin is an acute phase reactant so it can be elevated due to inflammation.

[Stavia]

Slacker, 200 points drop per 500ml? You mean 20? How quickly does it drop?
Jafa, I'm feeling fine, how you feeling?

Yes he meant 20, you don't get a 200 drop with each phlebotomy although some people do report a drop quite quickly from high numbers like 1200. You have to keep in mind that ferritin is an acute phase reactant so it can be elevated due to inflammation.

Yup I thought so too.
I wonder how long it would take the ferritin to drop - logically the iron stores would be taken up by new reticulocytes as a response to a drop in red cell mass - we usually check for a reticulocyte response 10 days to 2 weeks after iron infusion to monitor haematopoesis - any guesses?
I don't think ferritin is affected by total red cell mass right? But its a measure of iron stores?
I'm just very curious.

[simonh01]

Slacker, 200 points drop per 500ml? You mean 20? How quickly does it drop?
Jafa, I'm feeling fine, how you feeling?

Yes he meant 20, you don't get a 200 drop with each phlebotomy although some people do report a drop quite quickly from high numbers like 1200. You have to keep in mind that ferritin is an acute phase reactant so it can be elevated due to inflammation.

Yup I thought so too.
I wonder how long it would take the ferritin to drop - logically the iron stores would be taken up by new reticulocytes as a response to a drop in red cell mass - we usually check for a reticulocyte response 10 days to 2 weeks after iron infusion to monitor haematopoesis - any guesses?
I don't think ferritin is affected by total red cell mass right? But its a measure of iron stores?
I'm just very curious.

Its a measure of iron stores. Ferritin is a protein that stores the iron for later use. Here is my phlebotomy record. Last number is ferritin.

Date Blood Taken Ferritin
6/8/2016 1 500 ML RL 37.9% 13.3 251.6
7/20/2016 1 400 ML L 37.3% 13 280
8/31/2016 1 425 ML L 41.0% 14 192.8
9/21/2016 1 300 ML LR 38.5% 13.2 176.1
10/12/2016 1 300 ML RL 36.6% 12.6
11/2/2016 1 300 ML R 38.8% 13.2 141
11/23/2016 40.3% 13.7 118
12/22/2016 1 300ML L 39.0% 13.5 142
01/18/2017 1 300ML R 38.3% 13.7
2/15/2017 1 300ML L 40.8% 14.4 120.2

[simonh01]

Sorry thats not very clear here is just date amount of blood and ferritin


4/11/2016 000ML 239.8
4/26/2016
5/11/2016
5/25/2016
6/8/2016 500 ML 251.6
7/20/2016 400 ML 280
8/31/2016 425 ML 192.8
9/21/2016 300 ML 176.1
10/12/2016 300 ML
11/2/2016 300 ML 141
11/23/2016 000ML 118
12/22/2016 300ML 142
1/18/2017 300ML
2/15/2017 300ML 120.2

[Stavia]

That's exactly what I was looking for. So it's about a drop of 20ish for every 300ml-ish.
And good point that at high ferritin levels (1000ish) there will be associated liver inflammation so therefore venesection at those levels will possibly drop the ferritin faster as the inflammation associated with the iron overload subsides. I'd guess that at 200 or less the associated inflammation would be minimal.

[slacker]

So excited to drop unclear information and watch the results...

I find that the terms elevated iron, iron overload, and high ferritin are poorly defined and often used interchangeably. I'm just a cog in the wheel, so will not be held too responsible for this confusion. I was told that 1 pint or 500 ml (or cc if you prefer) of blood will allow ferritin to drop 200-400 points. I suspect that the words ferritin and iron are not used consistently here. So here is my attempt to clarify what I obviously don't understand:

In the US, Ferritin is stated in units of ng/mL, iron in units of micrograms/dL. Are we having fun yet? Just wait, there's more.
The Iron Disorder Institute (http://www.irondisorders.org/phlebotomy) indicates that drawing off 500 ml of blood drops ferritin by 30 ng/mL, and iron by 250 milligrams (that's 250,000 micrograms). Ok, so now we convert from dL to mL? 1 dL = 100 mL. This exercise will be left for the student...

My anecdotal observation of hepatitis patients with high ferritin (600 ng/mL +) is that their serum iron is within normal range. This may not be true at all since my observation is on a very small sample size. This being said, we would send no one for therapeutic phlebotomy based on serum iron levels alone. And correct me if I'm wrong, the medical establishment doesn't measure or consider serum iron as an acute phase reactant.

I'm not sure this solves anything, but I wanted to clarify my originally unclear thoughts on the subject!

[Stavia]

I never specifically look at serum iron. I sometimes notice that it's low in an unwell patient and then I use soluble transferrin receptor to assess if there is underlying iron deficiency underneath a normal or raised ferritin.

[giftsplash]

IP6 will drop iron levels very quickly in just a week or two.

[MarcR]

Thanks for the heads-up, giftsplash. Among friends my age, many are not eligible to donate blood, and as we saw from the Australian Family Physician article that slacker shared, professional phlebotomy may not be generally available due to public health policy.

There's a good thread on IP6 at Longecity that I plan to share with others.

[Dan Parkie 234]

A guide published by the Iron Disorders Institute, "Hemochromatosis" Second Edition has been tremendously helpful to me. My Hemochromatosis type 4B , also called Ferroportin disease or simply Iron Overload, was just recently confirmed by a hematologist with a blood test. I also have stage 1 Parkinson's and e2/e3/e4 alleles. I was first alerted to my hemochromatosis status (heamochromatosis in British English) by my 23andMe carrier report. I'm thrilled to be on a schedule of therapeutic phlebotomy to bring down my ferritin level from a recent high of 475.
Dan