Help interpreting iron panel


Kerry Isherwood
 

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

 


Eleanor Kellon, VMD
 




Tofurky is iron overloaded.  Important to keep your trace mineral ratios very tight.  Otherwise, the only way to attack it is by blood withdrawal.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001



Kerry Isherwood
 

....."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.

Here's a heads up on a question you didn't ask. Soaked hay can be a major source of iron in the diet if the horse eats a lot of hay.

My analyzed soaked hay almost always has higher Fe than the same hay dry. This is not caused by iron content in the water. Consistent advice is to rinse hay before soaking. IME rinsing hasn't reduced Fe if rinsing is followed by soaking. Soaking without rinsing always results in much higher Fe in soaked hay, based on 4 different loads of hay out here in the west. 

IME, feeding dry hay or just rinsing is the best way to avoid increasing iron in hay. Load 5 is being analyzed now. YMMV. We're in a terrible drought, and hay has been gritty for two years now.

Obviously rinsing doesn't address concerns about high ESC + starch in untested hay.

Cass for Cayuse
Sonoma County, Calif Oct 12

---In EquineCushings@..., <kerry.isherwood@...> wrote :

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:
***


Kerry Isherwood
 

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


lars_a_swe
 

---In EquineCushings@..., <kerry.isherwood@...> wrote :

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;

- - - - -
This isn’t an issue. First of all it takes time before the horse can absorb any iron from the foodstufs he is eating (a couple of hours before iron can be absorbed in the small intestine and several hours before iron can be absorbed in the large intestine). Secondly, the iron content in the current diet will only be reflected in serum iron which is pretty low for Tofurky (170 ug/dL). 

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.

- - - - - -

Anyone know if other factors influence ferritin in blood levels (stress, weather, etc)?  I really have got to take the NRC course...

- - - - -
The only way iron can get into the body is through the diet (including water and dirt). Stress and weather doesn’t increase body iron stores.

Lars
Sweden, July 2008


Jan Engelken
 

But serum ferritin is increased by other factors, too.

For example inflammation:

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
Germany, 2010


Kerry Isherwood
 

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


Eleanor Kellon, VMD
 




---In EquineCushings@..., <jan.engelken@...> wrote :

But serum ferritin is increased by other factors, too.

For example inflammation
= = = = = = = = =

That's true, but when inflammation is the cause there will be low serum iron and low transferrin saturation (serum iron/TIBC x 100) and it was high normal here.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Eleanor Kellon, VMD
 




Because the iron is coming from the diet, it only makes sense to avoid dietary iron as much as possible.  The actual requirement is no more than 45 ppm in the diet, which is almost impossible to achieve.  With IR horses, the S/S content also has to take top priority.

Dietary level is not the only, or even the most important, factor.  With IR, iron absorption is enhanced and in turn worsens IR in a vicious cycle:

Cross-Talk Between Iron Metabolism and Diabetes

 

Tight mineral balancing can help limit absorption.  Zinc at least, and possibly copper, competes for absorption on some pathways.  "Tight" means no higher than 4:1:3 Fe:Cu:Zn, and sometimes even lower.  This 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.


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 improve insulin resistance, e.g.


Iron depletion by phlebotomy improves insulin resistance in patients with nonalcoholic fatty liver disease and hyperferritinemia: evidence from a case-control study.

 

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Kerry Isherwood
 

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