Low red blood cells/ low Haemoglobin

[GC Gopro]

I wrote on this forum a while back and have found this site very useful. To recap my case, after years of a high purine diet mixed with regular beer consumption I had my first gout attack in January 2019.

Following this, I changed my diet drastically with trappist monk discipline, refusing the allopurinol and a year later my UA level had moved from 6.8 to 6.7, 0.1 was my reward. In April 2020 I started 100mg allopurinol after a second attack of swollen toe following a long walk. I had the usual burning joints and pain associated with dissolving crystals. In August 2020 we upped the Al to 200mg and my UA went to 5.4 the lowest value to date. Later I went back to 100mg and have been there since. My UA is around 6.0.

My animal protein intake has consisted of a small piece of salmon midweek and a chicken leg on Sunday with plenty of dairy, grains, vegetables, nuts, eggs, etc.

Just recently, I suffered a bout of being totally exhausted and blood test revealed low haemoglobin and low red blood cells, but not anemia. I upped my meat intake and felt a lot better for it and will have more blood test two weeks after the first test to review values.

Now the question remains was the allopurinol affecting the production of red blood cells in the bone marrow (a documented side effect) or was my iron consumption too low and also being blocked by the consumption of regular dairy foods. Apparently, rhubarb blocks consumption of iron and my wife cooked some and I consumed it the week before! Before gout I always had high iron on a blood test.

I am considering stopping the allopurinol for a period to see what happens to my UA score as low red cell production possibilities do not appeal.

Anyone else had this problem whilst taking allopurinol or had low blood scores like me? Thanks!

[nobody]

Hi,

I’ve sent an email to someone who also had (if I recall correctly) a problem with haemoglobin. Perhaps they’ll be able to help you.
In any case, you can stop allo for a while and see what that does to your blood. If it turns out allopurinol was the issue, there are alternatives, some of which might or might not have the same effect (you might have to experiment on yourself to find out).
But if your doctor think your haemoglobin problem isn’t too serious and might be explained by iron deficiency, perhaps try to fix that before stopping allopurinol.

If you’re going to stop taking allopurinol, consider taking heme iron (or whatever that’s called) supplements instead of eating meat. But you might as well eat meat if you’d be eating fish or chicken otherwise! It sounds like you were using the wrong information about diet, in which case discipline won’t help…
If you eat enough iron in the first place, dairy would normally not be an issue but of course everyone is different. If you have lactose intolerance for instance, you might want to try switching to dairy products containing very little lactose.

[d q]

Hi,

@nobody – it’s been a long time… A really long time. Will be in touch soon.

@Gopro – This is an interesting question as it opens up both iron and allopurinol as potential ‘culprits’ or ‘side effects’ to a low haemoglobin. What needs to be noted here is allopurinol effected my haemoglobin drastically and now use Febuxostat. The kidney’s constantly monitor the level of oxygen in the blood and based on the current levels a specific hormone called erythropoietin is released into the blood. If the oxygen levels are right, the kidneys secrete just enough to maintain correct red-cell turnover. If the oxygen levels in the body are low (low haemoglobin) the kidney’s release much more of this hormone into the blood which starts the signal to ramp up production of red blood cells. This technically increases the red cells and in turn the haemoglobin until things stabilise and oxygen levels return to normal.

I have an underlying condition which generally means I run at a lower level of haemoglobin however when I took allopurinol I had around a 20% reduction within 2 months. Now I am no doctor by any means however my theory is that because allopurinol is metabolised in the kidney it MAY have impaired production of this hormone or the ability for the kidney’s to correctly identify oxygen levels in some people. Unfortunately I learnt this too late and didn’t get time to check my erythropoietin levels prior to immediately stopping the drug to see how much of this hormone was actually in my blood.

From this you can take away two things.

1) Kidney’s monitor oxygen levels and release a hormone to adjust this
2) Allopurinol is metabolised in the kidneys

Is there a link in some people, I couldn’t get to find out as I stopped it right away and moved to Febuxostat. However maybe you still can….

The iron situation can and will affect healthy red cell production but too much of it can cause problems too. There would not be much point in going down the iron route until you had a test to see what level it is. You will need 2 tests (one blood test is enough). One for Ferritin and one for Serum Iron.

Once you have those levels and tally it up with the haemoglobin you will be able to see what may be causing the issue. It is essential however to have some previous tests to create trends as single results are always susceptible to noise.

Let me know if you need further help or advice.

Good luck.

[Author]

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