Yes, but you have CKD- that changes the clinical picture from OP’s, I’m afraid. The reason you are anaemic is a different aetiology from OP’s, the treatment pathway is different too. It’s not just “the will”, it’s about what local guidelines allow us to do. Locally, a Hb of 114g/L with ferritin of 14, due to menorrhagia secondary to endometriosis, who had not tried 3 iron salts and modification (e.g. taking in an empty stomach) and ferrucu would not meet criteria for referral by a gp or referral for infusion by a consultant. Clinical infusions would decline that referral, or seek further clarification/evidence of eligibility. If the Hb was significantly lower, she would be eligible without need to demonstrate intolerance in order to avoid need for blood transfusion. Similarly, the same results but a lack of response to oral iron, when taken regularly, is able to be demonstrated would also be eligible.
A patient with a different condition- e.g. inflammatory bowel disease, some renal conditions- with those same Hb/ferritin results would be eligible because we know they are far less likely to respond to oral iron, so it’s pointless. Whereas most people with mild iron deficiency anaemia (IDA) will respond to oral iron replacement, albeit more slowly than after iv infusions- but it is much more expensive and we don’t have capacity to give parenteral iron infusions to every patient with mild IDA. There are also risks with it, whereas there are very few with oral iron (intolerance causes unpleasant symptoms, it can be slow to be effective).
I’m not trying to not-pick. It’s just sometimes patients think if only we would just do the referral it would go through, or it’s because we don’t want to help/lack the will to push it through. Mostly, it isn’t.