Aibu to wonder if there's a nurse or GP about?

[tonyunclejohnny]

Hi so Ive been contact by my GP to say my iron levels are low.
Haemoglobin is 10 and Feratin is 3.

He mentioned getting advice from another Doctors as despite iron tablets etc they aren't coming up much further than that. He sounded quite concerned at the time. I didn't hear back so rang to see what was happening and the receptionist told me 'oh he's not that concerned now but I'll ask him to call you if he must'

The first time we spoke he mentioned blood transfusions etc as it's so low and it's effecting my daily life. Light headed, dizzy, some days I cannot string a sentence together. In fact I've been so exhausted they referred me to the rheumatologist to investigate chronic fatigue syndrome.

So now I don't know what to think. He's calling me tomorrow but just how low are the numbers above. If you are a GP/nurse what would you advise?

Thanks

Iron infusion - my levels were exactly the same and my operation was cancelled because of it. That's what I was treated with

What iron are you taking, how frequently, and for how long? Do you have any medical conditions or take any other meds?

I would advise 1 tablet per day, in the morning, on an empty stomach, with orange juice. Don't eat for 1 hour afterwards. This will help with absorption.

I would have you do this for 2 weeks then repeat the fbc (blood test).

Oh and no caffeine for an hour before or afterwards too.

Intravenous iron. You can be referred to gastro or haematology. You are symptomatic so need treatment. Hb of 10 is not bad. Under 8 is transfusion level. Commonest causes of anaemia in pre-menopausal women is heavy periods. Lack of dietary iron is also a cause. If unable to tolerate iron tabs try liquid iron.

Hi it's ferrous fumarate 322mg I take it twice a day. I have been on and off these since I was about 15. I have been taking solidly for about 2 months this time. I hate them they make me feel even worse and cause other issues too.

No other issues or medications. I found out my grandad had pernicious anaemia though.

I haven't had a period for years although I am on the pill, maybe 6-7years. I'm 36 so hopefully not menopausal!

I had similar levels years ago. Hb was 9 and ferritin 2! Dizzy, short of breath, tired, recurrent UTI's and knackered! Did they check your B12 also?

I was given the option of an IM iron injection. (into the muscle and not a blood transfusion). This works quicker than tablets, but, if the person injecting is not trained in Z track injections, you can end up with a permanent tattoo spot from the iron! I'm not even sure IM iron injections are still given?

How long have you been on iron tablets? What dose per day? It takes 3mths for red blood cells to fully replicate, so if you are on an over the counter dose, or haven't taken them long, then its irrelevant. The numbers won't increase quickly.

Food can have a massive affect on iron absorption too. Vit C helps increase the uptake, whereas anything with tannins can decrease it. Take you iron tablets with a Vit C rich drink or meal. Orange juice, peppers etc. Cut out tea, coffee and red wine in particular and never had these when you have an iron rich meal. I started eating liver (which I hated previously), more red meat and just being aware of what I was eating with the meal. If you have questions, just ask.

Sorry, cross post about the dose you are on. You may well have pernicious anaemia also.
Iron tablets can have gastic side effects unfortunately for some people. Spirulina is a seaweed which is natually high iron. You'd need to check that the dose is the same as the iron tablets, but its an option to look into, even if it was in addition to the regular pills.

Firstly, I think you should consider having the iron infusions. If they haven’t been explained to you, they’re not blood products, they’re iron and vitamin c sent though a drip. I have had several and you feel amazing afterwards.

You also really should find out WHY you’re anaemic so you can sort this out/have it sorted. The two most common reasons for anaemia in women are menstrual problems and stomach &/or gut disorders like reflux that can cause ulceration and slow bleeds, or illnesses like coeliac disease which can inhibit the absorption of nutrients. I assume when they tested your iron levels, they also checked your B12. (Best not to assume though…) Have you mentioned the Pernicious Anaemia as potentially part of your medical history? Do you have tingly/numb fingers or toes? Any of the symptoms?
Another reason is medications… (but don’t stop any, just make sure your doctor knows about any that you take, especially if they are over the counter meds like Gaviscon, Mylanta or other kinds of heartburn medication, and you take them every day.) NSAIDS like ibuprofen/nurofen can cause ulceration if you take it every day.
Or are you on a medication for reflux, a proton pump inhibitor (ppi) like Omeprazole. In rare cases, these can interfere with your absorption of trace elements like calcium and iron. (But don’t stop Omeprazole as ulcers are more dangerous!!!) There are also myriad other meds that can interfere with your absorption of nutrients, but these are the most common ones. Taking iron with vitamin c like a glass of juice (not grapefruit, because it contains an enzyme that can also affect uptake.) can help you process it better, but your iron stores are very low.
Hope that helps you understand what could possibly be the cause and what to talk to your GP about. As for the infusion, they are held in a clinic/hospital setting just in case someone has an allergic reaction. (Super-rare.) In my case, I could feel how much warmer and how much easier climbing stairs, etc was.

Btw, iron injections are rarely done anymore because the medication is very thick. It hurts and it can stain the skin, leaving a dark, “tattoo” shaped like a dot. The drip is considered the safer option as it is given at a slower dose, and if the patient is allergic, it can be stopped before they have had as much.

Lmao ask for a referral to haematology. They can look at why this is happening

I have this issue I just don't respond to iron tablets. I've had a few infusions and they do help. I do personally feel awful a few days after the treatment but it's definitely worth it.

Pre-menopausal means before menopause. If you have taken orally solidly for 2 months and not dented your ferritin and you have no periods you are probably not absorbing the iron. You need need it delivered a different way. Ask for referral to gastroenterology.

Either speciality (gastro or haem) can give you the iron. Gastro can however investigate why you are not absorbing the iron.

Gastro would be my first stop too Ire. Something is going wrong with your absorption if it's not coming up past 2 on tablets and you aren't having periods.

GP advise was to keep taking the tablets. Not low enough for iron infusion. Apparently being on my knees with exhaustion is normal and I'll get used to it. I cried thanks him for is time and hung up.

My gp said the same, that it wasn't low enough for an infusion, until an operation was cancelled at pre-op because of low ferritin.

I would honestly consider changing gp if you could find one who people report treats low Iron. Ask around your community

Fwiw haematology told me that iron tablets aren't always suitable

If heavy periods come into this, ask for a gynae referral too

Definitely ask for investigation to find out why your HB is low. The cause needs to be identified before the treatment.

@tonyunclejohnny

GP advise was to keep taking the tablets. Not low enough for iron infusion. Apparently being on my knees with exhaustion is normal and I'll get used to it. I cried thanks him for is time and hung up.

I think this is one of those times when a second professional opinion is definitely needed. Please go to another GP. Poor you.

If your ferritin is 3 you absolutely need infusion! Also stop taking tabs twice a day, you don't absorb anymore and side effects are horrible. Latest evidence suggests take them every 2nd day, assists with max absorbtion. Avoid caffeine and dairy and hour each side and take with vitamin c. Worth getting b12 checked if vegetarian/vegan.

I’m not a medic, but I have been anaemic.A few years ago I was so tired that I fell asleep whenever I sat down Kids’ swimming lessons, work… It to bred out that my iron levels were:
Haemoglobin- 9, Ferritin - < 1. My treatment was Ferrous Fumerate tablets too, and yup have to be rally strict about when and how you take it and how long for, as Eleoura and BangiChoons have said. I took the supplements for a year, with blood tests every three months. My levels did go up gradually, but only ever reached the lower limits of acceptable. Next step would have been to test for coeliac disease, without v can be a reason why someone is not absorbing nutrients. It is essential to take the iron supplements fir at least 3 months, on an empty stomach etc.

@tonyunclejohnny I have a similar issue and can’t tolerate ferrous fumerate - at least not well enough to take them regularly enough to help. The only one that has worked for me and allowed me to absorb without the side effects is Active Iron - really good. Often (and now) on 3 for 2 at Boots. www.boots.com/active-iron-30-capsules-10220795

Just an update, a different GP did more tests and it's coeliac disease!!

@tonyunclejohnny what tests confirmed your celiac disease? My
Iron has been dropping gradually since my son and I feel awful! I have tingling hands and feet

Glad you got to the bottom of it. Did you have to do a colonoscopy?

It’s a test for gluten intolerance that causes inflammation in your guts and prevents efficient absorption of nutrients. You do have to be eating gluten for the test to work though. Actual celiac disease is quite rare, whereas gluten intolerance less so.