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Opioids and blood iron

H

HJP

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Joined
Jul 31, 2015
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I donate plasma to supplement my limited income. Today I was not allowed to donate because my blood iron was too high. I am taking 12-16 mg of hydromorphone a day, and a 20mcg/hour Butrans patch. My doctor recently increased the hydromorphone from 6-8 mg/ day. Nothing else has changed (diet, fluid intake, etc.) . I drink loads of water constantly, since that is recommended when regularly donating plasma. I have been unable to find any information relating to opioids and blood iron. Any information would be greatly appreciated.
Thanks!
 
Personally, I've always been a bit anemic since my pregnancy, even years later I could not donate blood.
I'm going to move this to Healthy Living. Welcome to Bluelight!
 
I'm also not aware of a link. I'm surprised they didn't recommend you donate some red blood cells instead, which would bring your iron down. Have you looked into some regular blood donation?
 
Well, it turns out that at least in my case, there appears to be a direct correlation between blood iron and opioids. After much research and analysis, I realized that I had taken quite a bit more hydromorphone in the 12 hours prior to attempting to donate yesterday than usual. So I didn't take any last night, and only 2mg this morning. When they tested my blood this morning, my iron level had dropped 4 points, from 55 to 51, with 54 being the limit. Interesting that there doesn't seem to be any published information regarding this. So the moral of the story is, if you want to donate plasma, be careful how much opioids you take in the 12 hours or so prior to attempting to donate.
Thanks to those who replied, and I'll keep my eyes peeled for Magneto?.
And now back to our regularly scheduled programming...
 
That's really interesting. It might not mean that your red blood cell count is too high, but that your transferritin level is too high. Under certain conditions, your body will release ferritin (the stored form of iron) into the blood at higher levels, or reduce it. For instance, when the body is fighting infection, circulating iron tends to drop and ferritin stores tend to go up so that bacteria can't use the iron.

Maybe in some people, opiate use increases transferritin levels? That could theoretically mean that opiate use increases demand for free-circulating iron in some way, or it's messing with the hormone signals that cause more stored iron to be released. If the former is true, then it would mean long term opiate users should have a higher incidence of anemia. If the latter is true, then it should mean that when the opiate wears off the circulating iron would return to its stored, ferritin form.

Your hemoglobin or RBC would not go up within 12 hours of taking an opiate so it has to be the ferritin that's being affected.

What I don't get is that if you're donating plasma, why does iron matter? Once they separate the RBC from the plasma, there should be no iron in the plasma. I guess they wouldn't just toss the RBC though, they'd want to use it too.
 
Interesting information Foreigner. The RN with whom I spoke, clearly didn't seem to have the level of knowledge which you seem to possess. She said the reason that blood iron levels matter, is that when elevated, it effectively raises the viscosity of the blood. More iron, less liquid in whatever form. This slows both the rate at which the blood is drawn, as well as the rate that the hemoglobin, etc. is returned to the body.
Personally, I believe the true issue is greed. I've heard that they get $1200/liter for the plasma. So, if it takes an extra 15 minutes for someone with elevated iron, that slows down their turnover. Women, and a few men, can donate a liter in as little as 20 minutes. I usually take about 55-60 minutes. So it would (sort of) make sense that they would deny me if they had reason to believe that my average donation time could be extended. Whatever, now that I know what caused the issue, I can easily avoid the problem. At least until they come up with another reason to deny me. I would go elsewhere, but the options are few, and geographically limiting, since public transportation is my only way to travel. Thanks for sharing that info. Knowledge is the best weapon, err, tool.
 
After re reading Foreigner's post, some other things came to mind. My specific issue is clearly elevated ferritin levels. And since they separate the plasma from the hemoglobin and ferritin, and return it to your body, that enforces my theory that it's time that matters to this lab. Another thing is, I don't react to opiates as most people do. I can take huge doses of opioids and not get the euphoric affect, or "high", which many seem to achieve, and/or desire. Also, I don't suffer from the, what for many people, are extremely uncomfortable symptoms of withdrawal. I have other "oddities" to my metabolism, which at least up to this point in my life, have been beneficial. Good genes, I guess.
 
HJP said:
Well, it turns out that at least in my case, there appears to be a direct correlation between blood iron and opioids. After much research and analysis, I realized that I had taken quite a bit more hydromorphone in the 12 hours prior to attempting to donate yesterday than usual. So I didn't take any last night, and only 2mg this morning. When they tested my blood this morning, my iron level had dropped 4 points, from 55 to 51, with 54 being the limit. Interesting that there doesn't seem to be any published information regarding this. So the moral of the story is, if you want to donate plasma, be careful how much opioids you take in the 12 hours or so prior to attempting to donate.
Thanks to those who replied, and I'll keep my eyes peeled for Magneto��.
And now back to our regularly scheduled programming...
Click to expand...

Eh, registering a change that fast means your hydration levels have changed, nothing more. Next time make sure you drink plenty of fluids.

The nurse talking about your blood being 'viscous' is referring to your haematocrit/haemoglobin, not ferritin. I assume she did a pin-prick test?

If you extract plasma while you have a high hb level, you're at greater risk of developing a clot, which is why they won't take it. As I said before, I'm surprised she didn't offer to simply take a regular pint of blood, including the plasma. High hb blood is generally desirable (in terms of donation).
 
ice2x01, the regular rate is $25 for the first donation in a seven day period, and $35 for the second donation in a seven day period. You cannot donate sooner than 48 hours after the first donation, however, you may wait until 48 hours prior to the day of your first donation. So, if you donate on a Monday, the soonest you can next donate is Wednesday. But you could wait until Saturday, if you wanted to donate again on Monday. Confusing, eh? Now, if you are a new, first time donor, they advertise that you can receive $40 for your initial donation, and $60 for the second donation in a seven day period. To add to the confusion, in my case, for reasons not disclosed, (nor did I ask), I received $45/$65 the first week. This lab has many peculiarities. You cannot donate if your residential address is a motel, hotel, or a interim housing facility (homeless shelter). BUT they actually bus in donors from across the border in Mexico! I had been donating for over 90 days, and one day they called and told me that I could no longer donate because during a supposed "audit", the return address on the mail which I supplied for verification purposes was unacceptable. Huh? It took me 5 weeks to come up with a verification post card which the lab itself mailed to the residential address I supplied. This caused me great financial hardship, since I'm surviving on a small fixed income, virtually all of which goes to pay for housing. It would take an entire book to explain everything, but suffice it to say that I'm a multi disciplined Engineer, who two years ago owned two homes in California, seven automobiles, and due to a combination of the economy, and some questionable personal decisions, now finds himself depending on donating plasma to barely survive.

Now, CFC, I understand the relationship of hydration relative to donating plasma. I assure you I consume more than enough water to balance the other components of my blood. Which is why I was so puzzled when they told me about the elevated iron (their terminology, not mine). Once I did some research on hematology and hydration in general, analyzed my diet and fluid intake over the previous few days, the only thing where an obvious delta appeared was the amount of hydromorphone I had taken. I have severe facet arthrosis in both my lumbar and cervical spine. The evening prior to the morning when the issue appeared, my pain level had spiked, so I took considerably more hydromorphone than usual. So, since the increased opioid intake was the "smoking gun", I didn't take any for about 12 hours prior to returning the next morning to attempt to donate. My theory was seemingly validated when my "iron" level was reduced by 4 points to 51 from 55 in exactly 24 hours. All other parameters remained constant, so baring some unknown parameter to the equation, I'm left to believe that in my case, a direct correlation exists between the "iron" component that the lab tests for prior to donating plasma, and the amount of, at least, hydromorphone content in my blood. I'll verify this next Wednesday when I again attempt to donate. One thing I am going to do, is get some sort of electrolyte supplement to assist in retaining my level of hydration. I will continue to monitor the iron level in my blood, just in an attempt to further verify my theory. In the words of Mr. Spok, "Fascinating "...
 
Hi HJP,

I can understand why you think that, but let me just help you clarify what the readings you were given mean.

When you were told 'iron', what they actually meant was haematocrit (which is usually calculated as a multiple of a measured haemoglobin level). We know this because 51%, 54% (or 0.51, 0.54) etc are all measurements of haematocrit. In essence, this is a measure of the percentage concentration ('density') of red blood cells per fixed unit of blood.

The reason we know that your issue was due to dehydration was because it is completely physiologically impossible for your haematocrit to increase by such a significant amount in 24 hours. The body cannot produce that many red blood cells in that period of time, not least of which because RBCs take 7 days to mature from the point of creation.

Now when a person is dehydrated, their volume of fluid (plasma) to red blood cells decreases, and hence we come up with an increased relative concentration of haematocrit. On top of this, we know that a potential side-effect of hydromorphone is mild dehydration. So it's quite probable that your increased dose temporarily altered your fluid balance and caused a dehydration that was resolved once blood concentrations of the med declined to your regular dose.

So as said before, try to keep your fluids high (and raise your salts a little bit too) if you need to increase your hydromorphone dose above the normal before you plan to donate some plasma.
 
First, I've been using "iron" instead of hematocrit, (I'm pretty sure we're dealing with a spelling issue here, do some of you reside in the UK?), because I am using a smart phone, and not a PC with a full QWERTY keyboard. I would
use all the full technical terminology were that not the case. It's just a pain to type on a phone.
I fully understand the Hematology (U.S. spelling) of what we're discussing.
Now presenting that a potential side effect of hydromorphone is mild dehydration, is something I was unaware of, but definitely makes sense.
I appreciate all your input, and in no way am I trying to be confrontational. I think we're just dealing with a slight language barrier, and don't really know each other, or our backgrounds.
Thanks guys!
 
Hi HJP,

I know they told you 'iron', probably because that's what they say to donors to keep it simple, rather than using more complex medical terms.

But your 'iron level' is actually a measure of haematocrit (also known as PCV - packed cell volume) as I keep trying to explain. The number you were given does not refer to iron or ferritin or anything else. For example the range of numbers you would be given for actual iron is 9-27 in most labs, and ferritin 30-400. But neither iron nor ferritin is something that a donor centre would typically measure. Their only main concern is that your haematocrit is not too high, because that prevents them taking plasma.

Sorry if I confused you before, but hope this makes sense!
CFC

PS: if it helps, I'm a mod here, with a medical background, and quite a bit of experience of haematology, physiology and pharmacology :)
 
That's what I was attempting to convey - that I understand what the true technical terminology is, and I tend not to use it due to the difficulty/time it takes when having to use a smart phone to carry on conversations that are highly technical and verbage intensive. You are correct, initially, the Phlebotomist who performed the screening test which determined that my hematocrit level was too high told me my iron level was too high. Once I contacted a RN at the lab in an attempt to get some more in depth information on the issue, the terminology became more technical. I have always taken responsibility for my own health, and being a multi disciplined engineer, performing the required research, and becoming familiar with the terminology was sort of second nature. So, again, I appreciate your response and knowledge, and I'm sure we'll communicate more in the future!
 
Well, my theory that there, at least in my case, is a direct correlation between opioids and hematocrit levels in the blood appears to be true. When I was screened at the lab this morning, my hematocrit level was 43. That's down from 55 last Friday, and 51 on Saturday. Absolutely no other variables were different. Diet, fluid intake, etc., remained constant. My hydromorphone intake was the same, with the exception that I didn't take any for 12 hours prior to arriving at the lab this morning, and I didn't change my Butrans patch until after I donated. So, mystery solved. Nothing like the feeling of being back in control once again. Thanks to all who replied!
 
Well, so much for "being back in control". Tried to donate plasma yesterday, and my hematocrit level was back up to 56. Oh well, I give up. Just have to take it one day at time. I'll continue to analyze the situation, and maybe one day, some sort of repeatable correlation will present itself.
 
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