I think my iron levels are low but my GP disagrees - wwyd?

[JohnnyMcGrathSaysFuckOff]

I lead a very active and healthy lifestyle and generally have lots of energy. However recently my hair has started to fall out and I do feel tired and a bit emotional esp in the evenings.

Based on MN advice (thank you!) I booked a GP appt and was pleasantly surprised to be taken seriously. The GP immediately said, might be low ferritin. She ordered full bloods.

Thing is, these have come back now and my ferritin is 18ug/L whereas it describes the normal range as 11-307. These results are flagged as normal, no follow up required.

I can obviously see this technically is in the "normal" range, but it also feels like it's right at the bottom of a very big range.

In this situation, would you pursue? Try to supplement naturally? Or just leave?

No but they understand and can interpret blood tests.

me too. My ferratin needs to be about 100 to feel fine. I buy it over the counter. Ferrous fumerate you need to just buy some

Bad advice.

And a bit rude! OP you can take over the counter iron supplements

I took an OTC iron supplement when my iron was at the lower end of the range. I felt better within a few weeks. It's not a big issue.

if you are worried just buy some iron supplements

That level is for men - women’s levels are lower

I recommend beef liver/organ supplements, as it’s far more bioavailable than iron/ferritin supplements, the body recognises it as food. Obviously eating liver is great but personally I can’t manage it often. Also full of other nutrients (copper, b12 etc).

NHS always do this, you want your results to be optimal, not within their arbitrary ranges.

I just avoid the GP for stuff like this, put symmptoms into ChatGPT, ask what tests need done, get it done at one of the multiple sameday blood test places around then put results in and take the recommended action. I did this and got a supplement regime of things I was deficient in, iron being the key, and within 2 weeks felt compeltely better.

This NHS page says “ Several blood tests are needed to diagnose haemochromatosis.”
You'll have a:

• full blood count test
• liver test
• a transferrin saturation level test (Tsat) to check how much iron in the blood is bound to the protein transferrin. This shows if you have a high iron level in the blood
• a serum ferritin level test to check the amount of iron stored in your body

If your blood tests suggest haemochromatosis, you'll have a test to see if your DNA carries the gene associated with the condition.

These tests will help show if you have haemochromatosis, if you're a carrier of a faulty gene linked to the condition, or if you might have another condition that causes high iron levels.”

Did the GP rule it out because your liver test and transferrin saturation were normal or did she check your DNA for the gene?

https://www.nhs.uk/conditions/haemochromatosis/diagnosis/

There's a big difference between "within range" and "optimal". Optimal is 50 if you have a 'normal' lifestyle, 70 if you train hard or have heavy periods. (I'm not an HCP, but have had anaemia and ferritin issues).

@Blushingm according to NICE guidelines

"In all people, a serum ferritin level of less than 30 micrograms/L confirms a diagnosis of iron deficiency. Low levels of ferritin can result in symptomatic and functional impairment even in those individuals with a normal haemoglobin, especially in women who are menstruating."

The base level for my GP surgery is set at 30. I am still having regular periods which is why I was prescribed iron tablets when they reviewed my results. I was told on the phone when they informed me of my prescription that they wanted my ferritin to be at least 50 but ideally more like 75-100.

The OP was talking about the lower end and I quoted my NHS app acceptable ferritin levels and my results were labelled abnormal. Her level is 18 and mine is 24 and yet I am on iron tablets.

Yes as I acknowledged and apologised to the OP for being dismissive.

But glad to see the thread police are up and about nice and early.

As I then went on to explain that even with consistent low haemoglobin results and ferritin of 10 back in 2023 (was never re-tested but I have a FBC every 3 months and my consultant or nurse have never flagged my results) I've never had any treatment for anemia. The OP confirms in her first post that as she is "within range" so no further action is needed from her GP so she may have a battle on her hands to get anyone to listen.

It seems from this thread it's pretty common for us women to be left walking around with concerning ferritin levels and that NICE guidelines differ from the range given on blood test results. 13 being the low end of the "healthy" range we see on blood test results but 30 being the NICE guideline lower range?

In the interest of balance I have a relative who was called after a routine blood test and sent to A&E for an emergency blood transfusion. Ferritin was 8. But this was a man. When my ferritin was 10 no-one batted an eyelid.

I’d say it boils down to GPs not knowing how to interpret iron studies really.

ferritin is an acute phase protein, so is raised in inflammation. They should be measuring ESR and CRP alongside to diagnose inflammatory conditions, and realistically I would expect you to have symptoms. If inflammation is not seen on ESR/CRP then you should be referred to haematology to have genetic screening for haemochromatosis, a condition where you abnormally store iron.

It boils my piss that GPs and gynae are notoriously bad at interpreting iron studies - not all but certainly too many when they are the clinicians seeing iron deficient women day in and day out.

1. ferritin should be measured with transferrin saturation. The interpretation of both diagnoses iron deficiency and TSats will indicate if inflammation is “hiding” iron deficiency
2. you should have b12 and folate checked if symptomatic or anaemic (low Haemoglobin)
3. ferritin is an acute phase protein and so is raised in inflammatory conditions, you can have a normal-high ferritin and still be iron deficient. They should check ESR and CRP
4. serum iron is mostly pointless.
5. things are changing, “normal” lab values are being revised. The lower limit of 10-14 reflects the point that the body becomes anaemic through lack of iron. This is not the limit of what is healthy. NICE guidelines have said 30 for ages, this should be alongside a normal TSat and MCV.
6. Iron deficiency alone (without anaemia) is awful. Don’t be fobbed off when your haemoglobin (Hb) is normal. Your body is working so much harder to build proteins and cells, it is exhausting.
7. they need to establish a cause. In most of us gals it’s likely to be menstruation, are your periods heavy/changing? You only get iron deficient by losing iron (bleeding) or not getting sufficient in diet (either restricted intake or malabsorption from gut). So if you don’t have heavy periods and eat well then they should be looking for other causes too - eg FIT screening.
8. you should take medical-grade iron replacement consistently (usually alt days is enough, taking more than one/day is usually pointless), with OJ/vit C to aid absorption, and have levels checked after 6 weeks.
9. if no improvement then you have failed ora iron, they can try another type but I’d see if you can have an infusion instead (some areas only offer this for iron deficiency Anaemia rather than “just” iron deficiency. You can pay privately though)
10. recurrent iron deficiency requires gynae and gastro investigations. They might refer to haematology but it’s not really a haem problem as the blood isn’t the issue. Now with Advice and Guidance they would hopefully be told how to manage iron deficiency appropriately.

good luck! GPs are fantastic with so many things, iron is not one of them.

She didn't do the DNA test, no, but all those others yes. And I don't have the symptoms, so I expect that's what rules out the need for the DNA test.

The page you linked to says:

"If your blood tests suggest haemochromatosis, you'll have a test to see if your DNA carries the gene"

The blood tests didn't suggest it, hence no further test.

Well, they seem able to find lots of symptoms of inflammation - the IBS (during the investigation for this in 2020 was when the high ferritin was first observed), gynae issues (I've had persistent bleeding for over a year, had a fibroid and polyps removed, and an ablation), diagnosed fatty liver last year - they just say each time oh, yes, that's probably causing it.

But, if it's still high at my next test (due soon to follow up on the liver thing) I'll ask for the DNA test.

There's no family history of it though.

Coffee/tea aren't the only culprits for stopping absorption either... calcium can inhibit it, as can red wine!

So if you're eating your steak or liver every day washed down with a lovely malbec, chances are your iron level won't go up as much

How much are the same day blood places ? I've not heard of them ?

They absolutely might be right, raised ESR and CRP would confirm inflammation.

not to worry you, of all the haemochromatosis patients I meet only a couple had a family history. They were first diagnosed and then their family were confirmed to have it too. That said we see the worst cases who are symptomatic with sky high levels. But to reassure ferritin of 300 is raised but not dangerous. We treat to reduce the lifetime risk of accumulation, a diagnosis allow prevention.

@otherstories your post at 8.04 is a fantastic summary of iron related info. A lot of it is elsewhere in the thread but much easier to digest in one place and there are some points not mentioned elsewhere in the thread. Thank you.

I feel for GPs a bit as they are expected to deal with and treat whatever symptoms and concerns patients arrive with in an time specific appointment and cannot be experts on everything (or anything as they are General Practitioners). But so many patients must get iron related blood tests for so many reasons that understanding the results is a key part of their work.

Hopefully readers of this thread will be able to request the right tests including FIT tests, source supplements and devise their own treatment plan.

That's low. At my surgery under 30 is out of range. If you can tolerate pills you need high strength.
I've had low ferritin for years it causes so many problems. You definitely need to get it above 100 if you can.
When mine dropped to 15 I got an iron infusion the difference in how I feel is amazing it has sorted so many problems I didn't even realise were linked to low ferintin.
If your Hb is normal they will fob you off as it being fine to have low ferritin - it isn't it's debilitating!

Thank you for this - I was worried about taking iron supplements because my serum iron came back very high but ferritin is 24 - the low bar I need it to be to get an abnormal flag is 5!

Not a medico but I would be taking the symptom or fatique seriously.

Ask GP about ..
Colonoscopy
Bowel/stool tests
Helicobactor test
Heavy periods
Eye tests
Celiac and allergies
Mammogram
Skin check
Other things - brainstorm with GP.

Take Fefol or similar with orange juice only after medical advice but also eat more ..
Eggs
Fish
Red meat

And don't wait before you follow up to rule out any serious Illness.

Hi OP 👋 My ferritin was 11 (!) after my youngest daughter was born, and I brought levels up to more optimum levels of 70 by using a natural iron water supplement called Spatone.

I had to use a couple of sachets at a time, which was one more than the daily recommendations but I had no side effects, and felt so much better.

@dozer Im struggling with iron tablets, they all seem to make my stomach hard andf bloated and constipated.

Do you avoid this with the liver/organ supplements? Thank you!