From the Guidelines
Low ferritin, copper, and B12 levels in a patient with complex autoimmune disease despite normal hematocrit likely reflect malabsorption issues, chronic inflammation, or medication effects, and treatment should include supplementation and addressing the underlying autoimmune condition. The patient's complex autoimmune disease may be contributing to malabsorption, as seen in conditions like celiac disease or inflammatory bowel disease, which can lead to deficiencies in iron, copper, and B12 1. Chronic inflammation from autoimmune processes can also sequester iron, reducing ferritin levels, and certain medications used to treat autoimmune conditions can impair B12 absorption 1. Some key points to consider in the diagnosis and management of this patient include:
- Investigating potential gastrointestinal involvement with tests like anti-tissue transglutaminase antibodies for celiac disease 1
- Assessing the patient's dietary intake to identify potential insufficiencies, especially if they follow a restrictive diet
- Considering the use of oral ferrous sulfate 325mg daily, copper gluconate 2mg daily, and B12 1000mcg daily or B12 injections (1000mcg weekly for 4 weeks, then monthly) if absorption is severely compromised
- Monitoring the patient's response to therapy and adjusting the treatment plan as needed, taking into account the potential for iron deficiency, anaemia of chronic disease, and other factors that may be contributing to the patient's condition 1. It is also important to note that the normal hematocrit suggests that the deficiencies have not yet significantly affected red blood cell production, but without treatment, anemia may eventually develop 1.
From the Research
Low Ferritin, Copper, and B12 Levels
- Low ferritin levels can be an indicator of iron deficiency, as ferritin serves as a storage for iron and a marker for total body iron stores 2.
- In the context of autoimmune diseases, low ferritin levels may be observed, although elevated levels are more commonly associated with inflammation and autoimmune conditions 3, 4.
- Copper and B12 deficiencies can also occur in individuals with autoimmune diseases, potentially due to malabsorption or increased demand for these nutrients.
Hematocrit Levels
- A normal hematocrit level in the presence of low ferritin, copper, and B12 levels suggests that the patient's red blood cell production is not severely impacted by these deficiencies.
- However, it is essential to consider the patient's complex autoimmune disease and potential underlying conditions that may be contributing to these deficiencies.
Autoimmune Disease Considerations
- Autoimmune diseases, such as autoimmune hepatitis, can present with elevated ferritin levels due to inflammation and acute phase reactions 5, 6.
- In some cases, autoimmune diseases may lead to malabsorption or increased demand for nutrients like copper and B12, resulting in deficiencies.
- The patient's complex autoimmune disease may be contributing to the observed low ferritin, copper, and B12 levels, and further evaluation is necessary to determine the underlying causes.