Has anyone ever had Low Ferritin with Elevated MCHC levels?

[cristiana]

Hello All

I've just received some puzzling blood results.  My blood results have always been a bit odd since my coeliac diagnosis - a few things out of range, but the only thing my consultant has ever wondered about is whether I am developing a condition called Polycythemia, as my hemaglobin can be a little high at times.  He did mention last time I saw it that it can be caused by too much iron, so for the past 18 months since I last saw him I've started to eat quite a bit less beef, in an effort to keep my levels lower.

18 months ago my Ferritin reading 40 (lab range 30-206) but now it has come down to 26.

My first question is, would you say that that is a normal for a change in diet?  I do still eat red meat but probably half as much as I did 18 months ago. (I am postmenopausal incidentally).

Secondly, my MCHC levels which have always been on the high side and have never worried my consultant are higher than ever (355) - now ten points over 345, our local lab's highest limit for a normal reading.  (I did have almost as high a level at 354 in 2018 but my consultant wasn't concerned).

I see my bloods have been sent for a holotranscobalamin test which I gather is a new more accurate test for B12 and I shall be interested to know what the findings are as I think a high MCHC reading can be caused by issues with B12.

Sorry - I'm rambling here, but my second question is, could my low ferritin somehow be related to my high MCHC levels, or vice versa.   If anyone has had this issue, I should be really interested to know what they think.  

Cristina

 

 

 

Edited September 19, 2025 by cristiana

[trents]

Causes of High MCHC:

A high MCHC can also be due to anemia, depending on the type of anemia you have. Hemolytic anemia may lead to an MCHC measurement above the normal range.1 Hemolytic anemia develops when red blood cells break down faster than they can be replaced.8 This type of anemia can happen for several reasons, including:

Autoimmune conditions

Blood transfusion complications

Infections

Sickle cell disease

Higher-than-normal MCHC results may also be attributable to hereditary spherocytosis, a rare genetic condition in which the body makes abnormally shaped red blood cells.

https://www.health.com/mchc-blood-test-7092747

 

Cristiana, note the first listed cause, "Autoimmune conditions". Celiac Disease is an autoimmune condition. Do you have any other autoimmune conditions, which as you know, they tend to cluster? Anemia is also stated as another possible cause, which you seem to also have a mild case of with a Ferritin level in the below normal range.

[cristiana]

Hi Trents

Good to hear from you and thanks for your prompt response.  As far as I know I don't have any other autoimmune diseases but this elevated MCHC which has been in the background for some years now makes me wonder if I have something that has hitherto gone under the radar.   

I do wonder about B12 anemia.  When I was diagnosed with coeliac disease I was told by my nutritionist that had she been my GP she would have given me some B12 injections, she felt my levels were  far too low at diagnosis to just 'supplement'.  Since then, unless I supplement, my B12 seems to bump along the low normal readings. I wonder if my gastroenterologist may have ordered the newfangled B12 test for me, he may be thinking that perhaps the old blood test wasn't showing an accurate picture?

Iron anemia could be a thing, except strangely I have normal hemoglobin.  Anyway, I guess if he feels my ferritin shouldn't have gone down 14 points in 18 months I might need an endoscopy and colonoscopy again.

I think my coeliac disease is quite well controlled but these past few months I've probably been overdoing the gluten free oats which have made me uncomfortable and given me similar symptoms to mild glutening (which of course makes me wonder about the contamination of oats, as per that post a few weeks ago).  My TTG results will be telling.

Anyway, thank you for your suggestion, I suspect anemia of some sort or another could be to blame.

Cristiana

[trents]

Yes, there are different kinds of anemia. Ferritin is an iron storage protein so you can have plenty of iron floating around in your blood but not enough in storage in some cases. Also, the shape and size of red blood cells figures into all of this somehow. If they are the wrong shape and size they don't function properly for binding with oxygen like they should I believe, even though there may be plenty of iron in them.

[knitty kitty]

Hi, @cristiana,

@trents is correct.  Red blood cell size is important.

High blood glucose blood levels can affect red blood cells causing them to bloat, then shrink which causes the iron to become concentrated, thus higher mchc.  

Have you increased your carbs to compensate for reducing your meat?   All those oats?  Have you had an A1C test recently?  

My blood glucose levels go up not only if I overeat carbs, but also when I have digestive issues and chronic inflammation like from eating something I thought I was doing okay with but turned out not so.  I think you're on the right track cutting out the oats for a while! 

[cristiana]

Hi @knitty kitty 

Thank you, Kitty, and lovely to hear from you as well as trents on this one, I do appreciate your knowledgeable replies. 

Haemoglobin A1C and HBA1c have both come back as normal, so I think I am OK there - although I'll freely admit that I love sweet things and if they ever design a test which shows consumption of carbs over time that would be very incriminating: I do need to cut back.

The only fairly significant factor that has impacted my gut health recently was being stung badly by a wasp about about six weeks ago and  having to take flucloxacillin for a week - it gave me such a sore stomach and gut issues, and with the recent Oat Fest I haven't really been right since.  I seem to be a bit lactose intolerant again.  But I spoke to my husband this morning and he too thinks that we've radically cut back our red meat consumption, so I would think that might explain why I'm low on ferritin, at least to some extent.

But the gradually increasing MCHC levels really ought to be looked at so I am very grateful that either my gastroenterologist or the lab have suggested the holocolbomin test as I understand it is much better at detecting the true B12 situation going on, maybe there has been a deficiency all along?

Cristiana

Edited September 20, 2025 by cristiana

[knitty kitty]

@cristiana,

I'm glad your A1Cs have come back as normal!  

Penicillin based antibiotics like flucloxacillin can deplete thiamine, but low thiamine won't cause high mchc.  But SIBO bacteria will take advantage of low thiamine and all those oats to become overgrown.  SIBO bacteria can interfere with iron and B12 absorption and may cause high mchc.  

Certainly a head scratcher!  Hope the test results come soon so you can get this figured out! Keep us posted!

[cristiana]

@knitty kitty

I saw my consultant yesterday.  He is not worried about my high MCHC levels, he said he was more interested in my MCV levels and they are fine..

The Holocolobim test apparently is going to take time to come back - the report says 17th October which I think isn't actually the true date, I think it's just a random date thrown out by the labs to say 'Don't hold your breath!'. 

He mentioned B12 injections if the levels are low which I would really like as I've always felt in other countries my levels, hovering around 250, would be treated as a deficiency.  Doesn't help that currently I'm not sleeping very well at night, I'm so tired all the time, I'm hoping it will help me feel more energetic.  (Mind you, put me in front of the TV and I'm asleep in minutes!)  

When taking thiamin, what sort off food source or supplement would you recommend?

 

[knitty kitty]

@cristiana,

Thiamine is found in meats, which you've cut down on recently.  Liver is an excellent source of B vitamins, including thiamine and B12, and iron. 

Benfotiamine is a great thiamine supplement.  It helps promote intestinal healing.  Take a B Complex also, and magnesium.  Thiamine and magnesium work together.  Magnesium will also help relax you, so before bedtime is a nice time to take it.  The B Complex and Thiamine will provide energy, so take them earlier in the day.

[cristiana]

Update - my Active B12 is 36.  Apparently lab results between 25 and 70 suggest a possible deficiency, anything below 25 is a confirmed deficiency, above 70 is normal.   I am thinking this could be the explanation for my elevated MCHC.

Anyway, yet again I find myself bumping along the levels of low normal by British NHS standards, which isn't great, because from what I understand, in the UK our normal levels are set low and 'lower normal' levels would be considered a deficiency in such countries as Germany and Japan.

Regarding B12 levels, it doesn't look as if my levels are low enough to be offered B12 injections. 

That being the case, I remember reading that sublingual tablets can still be very effective but one particular type is better than another - I can't remember which type.  Can anyone help?

Edited September 26, 2025 by cristiana