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?

@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.

Ah sorry op! How odd they'd prescribe them then if they aren't absorbed.

Well in that case yes surely you're a candidate for IV iron.

It's very low. I felt absolutely horrendous when my ferritin was 8. I'd push for an infusion if it's this low and you are already on tablets.

Can you see a different GP?

Small rural practice (hard to move) & this GP is Head of Practice.

Re the absorption factor - I think the NHS just gives standard post bariatric meds. Some surgery simply reduces the size of your stomach, so you absorb as normal. Some, (the kind I had) also re routes your intestine so absorption is significantly reduced. And different bodies respond different ways too. Who knew that I would be 'malnourished' Vitamin & Mineral wise afterwards, or that it would leave me feeling so genuinely unwell? Not me, or I'd not have done it.

It's difficult as the GP's attitude is that I should be grateful for the surgery ('that I only needed as I'd 'got fat' anyway'). I guess that's true enough but it doesn't really help me now. I appreciate that no one here's said that. Thanks for encouraging me to keep pushing for IV treatment - I genuinely think I might need it now, esp with my Caring responsibilities. Fingers crossed (waiting for GP callback for 3 days now but I'll chase Mon if no reply - I might even write with my points)

Oh op the more you say the worse it gets. So utterly unacceptable that you get such a negative response from your gp.

Just go in all guns blazing. Say 7 is very low, not even borderline but very low, your current meds clearly aren't been absorbed (he should surely know that) and you want referring for iv iron infusions. Good luck - although you shouldn't need it! .

Are you not taking Vit D as part of your post op meds? None in the multivitamins?

There is some Vit D in the single multivitamin and mineral yes.
But I'm not being prescribed the extra vit D that the hospital thinks I am? If they are picking it up as sub par (2m later) then either its not enough or Im not absorbing it. Absorption is the problem. The Dietician said that the 'single bullet tablet has no effect for some Roux en Y patients'. I'm early 50's - it's been 3 years now and I don't want to feel this way for the rest of my life.

You poor thing. Ferritin that low will make you feel awful. Mine was 14. Luckily I’m in Australia and any result under 30 is considered too low. I was terribly fatigued unable to concentrates at work, awful insomnia and my hair was falling out. It was only the hair issue that made me get a test. I just assumed the rest was depression.

After a number of months on supplements I feel so much better. Hope you can get the help you need.

Well the only half decent GP at the practice was the one who called me last Weds 6.45pm (I was driving so couldn't take the call: called back Thurs 8.30am. Still waiting so called today and she is on hols til 18th)

Reception has made 'a blood test appointment for me for the 12th' but 'doesnt know what it's for you'll have to speak to the GP'. I can only assume its re the Ferritin. I am tempted to cancel it and when I speak to the GP simply explain I don't want any more bloods at present I just want treatment? (not trying to be difficult but entirely poss it will be fractionally different & they'll therefore deny treatement). By that point it will have been 3 months since the last bloods and 3 years since the surgery and its' been dropping steadily the whole time and I've become cumulatively more exhausted.

Similar to previous posters, I've also had very low ferritin of 9 and I genuinely thought I was dying. I had loads of symptons that I kept going to the GP sbout but GP kept palming me off before they finally did a blood test. I was on ferrous fumarate and it very slowly increased.
OP, could you take someone with you to the GP as a reinforcement? I've often thought I was too physically weak to fight my own corner when I felt really ill, but if someone could be with you they might listen to two of you? You really need to get this sorted so you can start to feel normal again.

I FINALLY got to speak to the GP!!
(meantime I'd had the 2nd blood test which showed exactly the same Ferritin level of 7 ug/L).
She's referring me back to the Sleep Clinic (I have Apnea)
She says she will 'discuss HRT with me if I insist'.
She asked me to 'try a higher dose of iron tablets and review in 3m'. I said I was not willing to as I've been on 2 x ferrous fumerate for 4 years and my iron has dropped from 21 to 16 to 12 and now to 7 so it ain't working. Plus I am a single parent to 2 kids with Autism and my health could begin to compromise their care. She said she will 'see what pathway she could put me on for IV iron (odd, as the Dietician at the Hospital already approved it in the letter) but she is reluctant as it carries a risk of anaphylatic reactions'. Is this so?
She has made a F2F appt for Monday. I have a feeling I'll need to be persistent which is hard when I can't finish my sentences / fall asleep.