There’s a case study of a 31-year-old female who was diagnosed with ulcerative colitis in 2007. And the iron markers were presented and the iron markers basically showed low serum iron, low iron saturation, low TIBC, low UIBC, and high ferritin, ferritin being about 162. And in that, Chris, in that presentation Chris mentioned she has chronic disease. Before I read the conclusions about the case, I thought that she would have low iron and the high ferritin was just due to inflammation. This patient does not have low iron. I believe you, obviously, and I can see why I did all the other markers that are there, but how do we know for sure this woman doesn’t have low iron? What is there in the information you have supplied that shows that her iron is not low?

Dr. Amy Nett:  This is a great question because you’re right, we don’t definitively know that she doesn’t have both low iron and anemia of chronic disease.

So the reason in this particular case, what seems to be more overwhelming in this picture, is the anemia of chronic disease because both the TIBC and the UIBC are low, right? Because TIBC and UIBC they’re inverse markers. So I think you mentioned here like that’s what you noticed, like she has the low serum iron the low iron saturation, but then if you look TIBC and UIBC in iron deficiency you would expect those to be high. So they’re low, so that suggests relatively high iron. And then her ferritin you mentioned, it’s high. It’s 162. So you know, her CRP and I don’t have the case open right now, but her CRP I want to say was like 167. So she clearly and she came to us in a really severe, like a desperate flare.

So she was in really bad shape. And so clearly she had inflammation, that’s what her CRP was. It would make sense if that ferritin was possibly high because of inflammation. And this is actually a patient that I saw and I basically, she came to us a little bit atypically as somewhat of a favor to someone, and so all I had was a hemoglobin, hematocrit, and I think MCV. And she just said, “Look, I’m dizzy, I’m practically passing out every day, I’m seeing blood in my stools.” And at the time of the initial consult, I said, “Okay let’s get you started on proferrin and/or liposomal iron.” Because she was just, she was at the point where she had been previously just before going to the hospital and she really wanted to stay out of the hospital.

So I didn’t have a full iron panel and so we actually just started her on some iron supplements. She actually did really well. I want to say we started her before running any tests again just out of desperation we started the proferrin, butyrate, I think we did butyrate enemas on her, curcumin and I think I started her on low dose naltrexone actually. So I think those four things and she had a pretty remarkable turnaround. So I think you’re right, there’s a good chance that she probably has a component of iron deficiency in there as well. But what’s more notable here is the anemia of chronic disease because of that mismatch with TIBC and UIBC. And remember this week we also learned that if you kind of want to dig in a little bit deeper you can also order soluble transferrin receptor. And I don’t think we ended up doing that in her, but that would be an option if you were on the fence and didn’t know whether or not to treat someone. Again, with her, honestly, I’d already started the iron on her, she felt so much better, we lowered the dose and kept her on it for just a little bit longer. But it’s a great point that you bring up, Justine. So thank you.