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Ferritin

Question
Hello,
I (female, 39 years old, CF, chronic Pseudomonas) suffered for a longer time from iron deficiency (ferritin below 10) with partly anemia. As the physical symptoms (exhaustion after minimal efforts, fatigue, pain in the neck) got worse and worse, I decided together with my general practitioner, to do an infusion with ferrlecit®. The above mentioned symptoms improved markedly. However I realized unfortunately after the infusions, that my secretions and the cough increased. After 4 of 6 infusions I stopped finally the infusions due to the worsening of the pulmonary situation. Now my question: what role does iron play for the metabolism of Pseudomonas? And is there an "optimal" value for ferritin in CF? Respectively could higher ferritin values (e.g. over 50) be a problem for the lung in CF?
Many thanks for your efforts.
Answer
Hello,
unfortunately there is only few data on this problem. Many CF patients have an iron deficiency. In how far this is clinically relevant, however, is not fully clear. If it leads to an anemia, that means a lack of red blood cells (erythrocytes), whose production is dependent on iron, than it is clear, that this could be a problem: erythrocytes transport oxygen and too few oxygen transport molecules, especially in patients with lung problems, have increased dyspnea and fatigue as a consequence.
In how far however a low iron or ferritin value can lead to clinical problems and which value is the ideal one, is not clear.
To Pseudomonas: we know, that Pseudmonas needs iron for its metabolism and there are even thoughts, to use this for therapy, in reducing iron in the lungs in order to stop Pseudomonas to grow there. Substitution of iron does not lead to increased iron in the sputum, as studies have shown.
There is a publication, that tested, if a substitution of iron leads to clinical worsening in case of CF, which however could not be shown (1). That however does not exclude, that this could be like this in your case (it is like this in medicine). My experience did not show this, either, whereas we use another iron preparation for iron substitution, that is better absorbed by the iron storages and with that you need less infusions. Until now, none of the patients has complained about the symptoms you reported.
Here you should talk about this with your CF physician in charge.
Best regards,
Prof. Dr. Joachim Bargon

1: J Cyst Fibros. 2014 May;13(3):311-8. doi: 10.1016/j.jcf.2013.11.004. Epub 2013 Dec 13.
Iron supplementation does not worsen respiratory health or alter the sputum microbiome in cystic fibrosis.
Gifford AH1, Alexandru DM2, Li Z3, Dorman DB4, Moulton LA5, Price KE6, Hampton TH7, Sogin ML8, Zuckerman JB9, Parker HW10, Stanton BA11, O'Toole GA12.

16.01.2017