Ferrtin level of 7 ug/L - is this *really* low please?

[52andblue]

Background: In 2018 I had a gastric bypass (NHS). I have had mobility problems for many years (as a result of an NHS cock up sadly now unfixable). My BMI had crept up to 44. I was put on 'pathway'. I dieted & reduced BMI to 37. I was then borderline for surgery but because of my mobility & sleep apnea my surgeon strongly suggested I go ahead so because I wanted to improve my health long term, I did. I regret it.

My NHS area contracted out the surgery and comms were poor. My long term meds were not set up properly. I have lost weight but been ill since. I lost my job as I was fainting and exhausted. Neither my old surgeon, the GP nor the dietician is interested when my annual bloods 'borderline' each year. I regret the surgery: my quality of life is reduced.

I have just chased for the results again. It has taken 2 months but I now have a copy letter only just written to my GP by the dietician.
My Ferrtin level is 7 ug/L which letter says is 'slightly low' but NHS website says is 'critically low'.
My Vit D level is 41.3 nmol/L (should be 75+) and my Manganese is 334 mnol/L (range 70-280)

The letter says I can be given 'more iron tablets' or IV infusion at this level. My GP wants to do a 2nd blood test and review in 6m. I dont. I have felt awful for over 3 years now, and these are the results when I am already taking the supplements (finally given, although it transpires the Vit D I should be on was 'missing from prescription')

I am still mobility impaired and I am a Carer for my 2 kids with ASD. I am also now a single parent. I need my health to be as good as possible (why I agreed to the surgery to start with). I have awful brain fog, I feel giddy, I don't sleep well, I am anxious, & I'm SO TIRED.
GP just says: 'depression'. Dietician 'wonders if it is menopause';.

They won't reverse the surgery (my preference) but I think they should at least try everything to improve my deficiencies as I cannot do it by diet / vitamins myself. It may also be peri menopause (I'm 53 but still regular) / depression but I think it's the low iron / D etc that needs fixed.

In my position do you think it is reasonable to push hard for IV for iron?

Yikes - sorry for 'essay' - didn't want to drip feed info.

hoping someone out there as might have to speak to GP later

I think it's really low. Isn't 11 considered borderline?

I may report this and ask for it to be moved to Chat to see if I can get some more input before GP call later on (hopefully, been waiting 2 days)

(I appreciate NHS hard pushed atm but less so in 2018 when Op done)

It’s extremely low. I don’t know why GPs in the UK are often so dismissive of low ferritin. It’s awful of your GP to recommend going another six months without addressing this. Perhaps ask what he thinks your ferritin will be in six months? Definitely push for an iron infusion.

I’m sorry you’ve had such a very hard time.

It’s extremely low and is dangerous. The UK has one of the most wide ranges for ferritin in the world. If you speak to any haematologist they will say for your body to function adequately your ferritin needs to be 150+. At 7 you must be absolutely riddled with symptoms. Don’t be fobbed of

Low ferritin can cause many of your symptoms, @52andblue: extreme fatigue, brain fog, dizziness, depression/anxiety. What’s your haemoglobin?

Definitely push for an infusion. Doctors don't take this seriously enough. My ferritin was 3 at one point and I was told to go away and take tablets for 3 months, and then denied a follow-up blood test to see if they'd worked.

I now take regular private tests and have slowly dragged it up to 50. I'm less anxious and exhausted than I used to be, but I wish I'd had a quicker way to improve.

Thanks for the replies.

The letter to the GP (sent 2 months after my blood tests) just says:
'urea, electrolytes, liver function, corrected calcium, albumin Vit B12, folate, CRP and haemoglobin were all normal'.
But this dietician has mis-reported results before for both me and a friend of mine (also had surgery and I believe actually reported the HCP over bad follow up). Certainly she seems to think I am being prescribed a Vit D supplement which I am not.

The thing is these results are after 3 years of post Op supplements.
I don't want to wait any longer to feel normal again.
Before, I was fat yes, but I was totally normal. Normal to low BP, no anaemia, no raised cholesterol, not diabetic (or borderline). I wish I could turn the clock back. I've lost my job, I'm asleep mid afternoon and I can't string a sentence together. I'm scared of fainting crossing the road again (fainted at a station nearly fell onto track) It's crap.

Sorry for protracted whinge

It is low but they rarely do anything other than take iron for 3months. Mine has been 4 hospital refused to do anything even though v dizzy at GP surgery and they said it’s low enough for Iron transfusion. It seems unless you are due an operation where you may lose more blood or can’t tolerate iron tablets at all. Not just make me feel sick and give you bowel problems for months you are on you own!

That’s awful, but as OP has had a gastric bypass they may/should be more willing to refer for IV ferritin.

I've heard wonderful things about UV iron. I'd go for it. I've had ferritin levels of 3 and

At my lowest i was at 2 and i kept having weird blackouts (I didn't faint but my hearing and eyesight would just cut out). I had 400mg of iron a day for 3 months and managed to just get up to the minimum that was about 20 i think. The doctor was amazed I was still walking and talking. I had donated blood the week before and passed the iron test. My blood iron was fine i just didn't seem to store anything

Gps just don't seem bothered by low ferritin as long as there isn't any aneamia. Mines been 5 before and I just took ferrous tablets.

You won't need an iv, sorry I've read your op but can't see why your gp won't prescribe tablets? Just ask for them, you've a low ferritin and should have 3m ferrous fumarate.

My 85yo mum's iron levels went really low and she was so ill. We'd been saying to the doctors for ages that she needed help but they left her til she was in danger of organ collapse. It was only because I stayed with her and one night thought she wasn't going to survive the night that they even did blood tests. She had to have both blood and iron transfusions. She was like a different woman afterwards. She was off walking a mile with ease whereas before she couldn't even make it to the bottom of her drive. Her levels had been at 8 and they thought she was OK on tablets but then they kept falling. Definitely push for the transfusion - it doesn't take long and quite straightforward.

OP if it helps you can buy ferrous sulphate from the pharmacy without a prescription.

Just ask for the strongest iron tablets they have and they can sell them OTC.

This is in Scotland btw. Cant imagine it's different for England.

'Definitely push for the transfusion - it doesn't take long and quite straightforward.'

I do think it is generally only in people like your mum who are very ill, aneamic and need a blood transfusion that they would give iron IV. In those who have a normal hb tablets would be the first line in treatment.

Mine was 7 and I was given ferrous Fumarate. I managed to take 3 a day as it didn’t cause constipation, a lot gentler on the stomach.

I buy the ferrous Fumarate over the counter.

As an aside for those with persistent low ferritin and don't like ferrous tabs I find Spatone really good. It only has a low iron content compared to prescription meds but there is more bioavailability so we get enough apparently.

It's extremely low and depression and tiredness and brain fog are a side effect of this.

Mine was 6 and I was told boarderline transfusion but iron tablets had got my heamglobin up so we just continued iron.

Sorry if any confusion - I'm already ON 3 x ferrous fumerate tabs.
This is my bloods ON these tablets - the surgery means my gut doesn't absorb them.

@JaniieJones

'Definitely push for the transfusion - it doesn't take long and quite straightforward.'

I do think it is generally only in people like your mum who are very ill, aneamic and need a blood transfusion that they would give iron IV. In those who have a normal hb tablets would be the first line in treatment.

I understand what you're saying but some people have problems absorbing the iron and so tablets are not effective. The op sounds quite informed about her own health and is already taking supplements which don't seem to be working. I honestly never knew you could become so ill from lack of iron. Mums doctor was all about wait and see and so we waited and saw her into an emergency hospital admission in the middle of covid. So if I had a letter saying that an iv fusion was a viable course of action, that's the way I'd go.

@52andblue

Sorry if any confusion - I'm already ON 3 x ferrous fumerate tabs. This is my bloods ON these tablets - the surgery means my gut doesn't absorb them.

And that’s why I think you should be a good candidate for an infusion. You could ask your GP what s/he thinks will raise your ferritin in the next six months, as oral supplements clearly are not.

I'm a big believer in telling the GP firmly exactly what treatment you want for your own body. And if they persist in saying "no" then get them to explain exactly why not, and what WOULD "qualify" you for the treatment.

But in the meantime, I would strongly recommend liquid iron (feroglobin otc, or you can get something stronger on prescription) for ease of absorption.