Hi group,

In the ongoing work-up of my gelding's unexplained hyperinsulinemia, so far bloodwork is normal except for part of the KSU iron panel.  Here are results for both of my IR horses, as both have abnormalities in results:


TOFURKY, 8yo IR gelding

serum iron... 170 ug/dL  (reference range 75-288 ug/dL)
TIBC...  411 ug/dL  (231-455 ug/dL)
ferritin...  340 ng/mL  (43-261 ng/mL)  **HIGH** 

(other bloodwork wnl:  ACTH, CBC, SPEP;  still pending:  lyme multiplex, ehrlichia titer)

--------------------------

PINKY, 21 IR/PPID mare

serum iron...  206 ug/dL  (reference range 75-288 ug/dL)

TIBC...  498 ug/dL   (231-455 ug/dL)  **HIGH**

ferritin...  223 ng/mL   (43-261 ng/mL)

--------------------------

Any quick comments?  I will add results to CHs and search in archives for info on above tests, but pertaining to the gelding's current  hyperinsulinemia, does the iron panel results mean anything significant that I need to do or change asap?

Hopefully the link to Tofurky's CH will work:

ECHistory8

Holy crap, I think I finally figured out the CH linking!

Pinky, the mare, is stable at the moment (mercifully), just beginning to increase her pergolide for the seasonal rise.  She has been hyperglycemic and occ PU/PD last few weeks, hence the bump from 1.5mg pergolide to 1.75mg.  I will update her CH asap and include the recheck ACTH once she's 3 weeks on higher dose of Prascend.


Thanks so much,
Kerry in NY
Sept 2014

 

....."Tofurky is iron overloaded. ...(cut)... the only way to attack it is by blood withdrawal.".....


>>> Like an old-fashioned 'blood-letting'?  What about leeches, does Uckele sell medical leeches?

;)))

Thanks for the response.  I will discontinue my beloved Farrier's Formula and the alfalfa pellets.  I'm getting the new hay analyzed which I'm still soaking, but aside from the long stem hay, is there anything else in Tofurky's diet that should be decreased or removed that would contribute to iron overloading (again, aside from the unknown hay at this point, which of course may change things).  His current diet is:

All mixed together, fed 1x/day:
~3lbs ODTBC soaked into mush
2 scoops SEROQUINE pellets (per Dr. Kellon)
3 1/3 (10g) scoops ALCAR (per Dr. Kellon)
5 mls (2500IU) Vit E in oil (Uckele)
1 oz ground flax (Triple Crown Omega Max)
1 oz iodized salt (refuses to eat more)
1 scoop Pro-lyte (Uckele) electrolytes (on days after hard work)

Are any of the above supps or doses contributing to iron overload?

Also, is it worthwhile to retest the iron panel after dietary adjustments, and if so, how long after changing?


Thanks, always so much to learn...
Kerry

Hi, Kerry.

Cass,

Thanks so much for the info abt soaked hay.  Very interesting.  Unfortunately, the blood sample was drawn while Tofurky was eating unsoaked hay (25% of hay diet) and ODTBC (75% of hay diet).  The analysis on the long-stem hay yielded an iron level of 111ppm (50 mg/lb) as sampled;  122 ppm (56 mg/dL) dry matter.  Assuming there is minimal iron in OCTBC, then the only other sources of iron would have been:

Seroquine pellets (2 scoops)
Farrier's Formula (1/2 cup, adult maintenance, orig formula)
Pro-lyte electrolyte (1 scoop)
ALCAR (10g)
alfalfa pellets (Standlee) ~3lbs
water

I cannot think of any other ingested foodstuffs that he was receiving (no grass, no treats, etc).  Anyone know if other factors influence ferritin in blood levels (stress, weather, etc)?  I really have got to take the NRC course...

Thanks,
Kerry in NY
Sept 2014

Serum ferritin iron, a new test, measures human body iron stores unconfounded by inflammation.

 

The fascinating but deceptive ferritin: to measure it or not to measure it in chronic kidney disease?

 

Jan

Hi Lars,

Thank you very much for reply. A couple more questions, if I may:

....."Secondly, the iron content in the current diet will only be reflected in serum iron which is pretty low for Tofurky (170 ug/dL)." ....

then i should consider the diet at time of blood draw "ok" in terms of iron intake, which is reflected in serum iron on bloodwork, if Im understanding correctly?

Said another way, serum iron is a snapshot of daily iron intake (roughly) while ferritin reflects the lifetime accumulation in body stores? Is that (painfully) correct?

......"The value to worry about is for ferritin (340 ng/mL) which is a measurement of stored iron in the body. This iron have probably been built up in the body (mostly liver and spleen) during many, many years."....

Aside from blood-letting, as Dr Kellon mentioned, how does one "get rid" of excess ferritin? Ive read that sweating will leach tiny amts of it but its miniscule (however, my gelding does sweat ALOT, so there's hope ;) Will having a tight mineral balance on diet actually reduce ferritin stores, or will it simply just not add to the already high amount?

Thanks again
Kerry in NY
Sept 14

Thanks Dr Kellon, very interesting.

....."[tight balancing] seems to allow the body to gradually drop iron stores as it uses them to fulfill iron requirements. It takes at least a year to see any significant changes.".....

that being said, is it worth rechecking ferritin annually (or q18months) on a known IR w history of high levels? Is it worth checking serum iron periodically to assess dietary absorption status? And furthermore, is a serum iron level a useful tool in ascertaining control of IR status?

Maybe im overthinking this...

....."Although it's not something you are likely to see happening in your GP's office, phlebotomy/"blood letting" has been studied and used to reduce iron burden and (snip)".....

when I worked critical care i saw two cases; one an idiopathic polycythemic dog that happily walked around w a daily Hct of 80%. It was always a tense moment when Medicine disposed of the literal liters of beautiful blood and an ECC person walked by and cried "OMG cant we somehow keep it for parvo puppies or something??" Other case wasnt true phlebotomy but involved Surgery showing off their shiny black leeches (meant for a nasty wound) to any new employee or unsuspecting intern. Not cool, even as earrings.

Kerry in NY
Sept 2014