High MCV, low ferritin?

[lotusbud]

Hi,
what would mean to have a little high MCV (mean red cell volume) around 100, and low ferritin around 20? Ferritin was at 6 seven years ago, so I got it up... a little. Meanwhile, iron is normal most of the time, with little dips, B12 and folate are normal, also with dips, Hgb from 12-13 more or less.
Also in bone marrow biopsy was no iron.
What does all this mean?

Suspect MDS, 2008

[Dick S]

lotus see my response in your other post. I have the very same thing on these counts (High MCV) and I am not sure either what they all add up to with the other numbers, I guess only the Hema knows.

[tytd]

Hello lotusbud,
If you had a recent bone marrow showing no iron stores and your ferritin level was low, that means that you have some iron deficiency even though your serum iron level may be normal. I had a similar problem. I would ask your doctor about iron supplements and he/she may also want to check you for any abnormal blood loss perhaps from GI tract or heavy menses which may be causing your low iron stores. MCV is often elevated with MDS but it sounds as if this diagnosis has not really been confirmed in your case. Some of your fatigue might be due to iron deficiency. Tytd

[lotusbud]

Thanks,
the ferritin has been consistently low for at least 8 years that I have records. I have taken courses of iron supplements, and got from 6 to 19.. which still means it is below normal. I got a course of B-12 two years ago, for which I was becoming allergic (also allergic to B-5), so the hemo also declined iron shots for fear of allergies. Otherwise, my orthoped said I might get iron overload if taking too much iron:

Jan 2010
Hgb 13.6 (11.6-16)
RBC 3.88 (3.8-5.3)
WBC 4.1 (4.5-11)
Hematocrit 38.8 (35-47)
MCV 100 (79-97)
MCH 35.1 (27-34)
MCHC 35.1 (31-36)
13.8 (11.6-15)
Plates 204 (150-450)

ferritin 19 (20-291)
transferrin 258 (160-360)

The red cells have enough iron. My hemo also said the low iron may bring down the MCV.
I got some checkup done but still think there may be a leak of iron or blood - otherwise where would it go?
Yes the MDS is suspected, but it seems pretty certain something is the matter. And perhaps it is iron causing the fatigue..

[Zoe's Life]

Lotus,

I too have low ferritin and two BMB's show no iron in the marrow. My hemo says it is because of the MDS. I don't know, I guess she knows what she is talking about, MDS is her specialty. Like you, my MCV is always high (that is clearly from the MDS). I have to say that, AMA (although I did tell my hemo last time I was there, and she didn't try to talk me out of it), I am taking vitamins with iron because it seems to help keep my hemoglobin up. After several months of taking the iron fortified vitamins, I had my ferritin tested just to be sure I wasn't getting too much. My ferritin was only 44 (on the low end of normal). I have never had heavy periods, so that isn't the cause of the low ferritin. I have had a colonscopy, chest CT scans, ultrasounds (had another today on my gallbladder). Nothing that would explain the low ferritin. I have seen other MDS patients say they have no marrow iron stores, even with normal ferritin, serum iron, etc. I have never had an answer I understood.

Zoe

[lotusbud]

Hi Zoe,
within the last 8 years my ferritin has never been higher than 21, usually much lower. My hemo is not excited, for him I may or may not take iron. However, my ortho said that "there is no room" in the marrow whatever that means. He is good and very knowledgeable too. But apparently there is a danger of getting too much. Curiously, I do need more iron near period though it is not heavy; sometimes have terrible headaches/neck pains. I do supplement occasionally with iron, because a few times I was hovering around the lower Hgb limit.
Lotuslady

[Zoe's Life]

Lotusbud,

my ortho said that "there is no room" in the marrow

Thank you for that. That makes sense to me. I am guessing it means that with MDS, often the marrow is hyperplastic (it produces lots of new cells). The problem is the cells are not healthy and they die in the marrow. So you have extra cells, and dead cells, leaving no room for iron. I don't know if this is correct, but it makes sense.

Zoe