Anemia, Hair Loss, and Iron Infusions

Anemia occurs when the body does not have enough healthy red blood cells, which is vital for carrying oxygen into body tissues. Anemia can be caused by several conditions. However, for the purpose of this blog I am going to share my experience with anemia which began after I experienced massive hemoptysis in February 2011.

                                       My Hair is Falling Out!
One year following my experience with massive hemoptysis, in February 2012, I decided to go to my salon for pampering and candy coffee. The girl washing my hair kept saying how beautiful my hair looked and how soft it was. I was thrilled with my new hairstyle and couldn't wait to get home to show it off. Well, just before leaving the salon my stylist gave me a large handheld mirror to check my hair before I left; it looked lovely. But there was a major problem. I realized the lighting in the salon shined through the front of my fine, thin, blonde hair and my scalp was clearly visible through my hair. What?!? How did I not notice this before now? I knew I had been losing an unsual amount of hair because we needed to use draino weekly due to my hair clogging the shower drain. I was losing hair all over the house, even even stopping my vacuum cleaner's rotating brush in its tracks. Every few times I vacuumed I had to spend an hour cutting my hair out of the bristles on the vacuum cleaner's spinning brush. The most prominent area of hair loss was the top of my scalp and around my face. Something was wrong within my body. I asked myself, "What is wrong with me now?" I was determined to find the answer sooner than later.

                               Dermatology Consult for Hair Loss
I saw a dermatologist who I'd seen years before when he was a resident on the pulmonary team. I told Dr. S. about my hair loss. He listened to me thoroughly and patiently as I described my hair falling out. His attending seemed to think my hair looked fine and was not thinning; I respectfully disagreed with her stating that I was indeed losing an unusual amount of hair for me. Thankfully, Dr. S. decided to test me for anemia and thyroid conditions. A few weeks later I was readmitted to the hospital and I called Dr. S. as soon as my labs returned showing that I was anemic. He then explained to me that I had been anemic for quite some time and that it can contribute to hair loss. I was surprised.

Dr. S. recommended that I speak to my team about iron infusions and I did (for a reference point, my ferritin level was only one point higher than the lowest number the lab uses in the reference range). I was given two sodium ferric gluconate infusions during this admission. Two infusions of SFG were not enough to restore my RBCs. SFG is typically given several times over several weeks to restore WBCs. Needless to say, my symptoms of anemia, hair loss, and poor hair growth continued.

                         Hematology Referral and Iron Infusion
A few months passed, my hair continued to fall out, and I was in and out of the hospital. Finally, I decided to schedule an appointment, based upon Dr. S.'s recommendation, with Dr. M. at the hematology clinic. I wasn't expecting a miracle. Dr. M. and I discussed symptoms of anemia: fatigue, memory fog, hair loss, and pale skin. I was experiencing all of the aforementioned symptoms. I'd become so used to walking around with these symptoms that I accepted them as my new "baseline of health" except for hair loss which obviously concerned me. I was severely fatigued, which I attributed to being "CF sick" as I was in the midst of what seemed to be a never ending exacerbation with frequent hemoptysis, fevers, and hospitalizations. If it wasn't for my complete devotion to my lungs and being consumed by taking care of my lungs, I probably would have spoken up sooner about my hair loss and thus received proper treatment for anemia. 

Within 24 hours of seeing my hematologist I was sitting in the infusion center and receiving a large bag of Iron Dextran. This type of iron typically only needs to be given once to restore all of the iron as opposed to the sodium ferric gluconate I was given during my admission, which requires multiple infusions over several weeks to replenish iron levels.

                                            Side Effects
I experienced the common side effects of body aches, fever, and fatigue for the entire week following the Iron Dextran infusion. But after one week the side effects disappeared and I hoped for the best not knowing if the infusion would make any difference in how I was feeling or the awful hair loss that prompted me to see a dermatologist in the first place.

                                Six Weeks Later: Improvements!
It has nearly been six weeks since my iron infusion. I have certainly experienced an improvement in my overall sense of well being. For example, I used to feel shaky and cold (glucose was normal) throughout the day even when the temperature outside was 100+ degrees. I complained of everyone "freezing me with the a/c" in car rides, restaurants, and when I visited family members. Now I crank up the a/c full blast because I actually get hot and sweaty! I had not seen my golden ivory complexion in over a year. I was pale with a gray under cast to my skin that I hid with Makeup Forever HD foundation. Now? My natural complexion is back in addition to rosy cheeks! Other than side effects to some medications, I do not feel like I have "memory fog" like I once did. I have also noticed a mild improvement in my energy. Rather than passing out from exhaustion before 9pm I am now able to stay awake until 10pm and I do not need naps as often as I did before my iron infusion. Lastly, I am happy to report my hair has finally stopped falling out and I see new hair growth coming in around my hairline! I cherish these little baby hairs growing in, even the gray and white ones!

The best part of all? My red blood cells are, for the first time in a year and half, within normal limits! I am no longer anemic! Furthermore, the size of my red blood cells have increased! My hematologist believes that having my RBCs within normal limits will buy me some wiggle room due to having frequent hemoptysis. She also said, "The more anemic you are, the smaller your blood cells are, and the more likely you will be to experience issues with bleeding." Finally, my hematologist took me off the GI irritating iron supplements indefinitely. She said when I need to "fill up my iron tank" I will have an iron dextran infusion since it helped me significantly faster than the supplements I was taking without the harsh GI side effects.

                              

                                            Symptoms of Anemia
1. Feeling Weak

2. Headaches

3. Problems concentrating

4. Palness of the skin

5. Blue color to the whites of eyes

6. Light-headedness upon standing

7. Shortness of breath (not indicative of anemia in CF patients due to underlying lung disease).

8. Sore tongue