Low Hb doesn't seem to improve

[LavenderRains]

Hi I'm concerned about my DF who had heart surgery 14 weeks ago. Before surgery his Hb was 130
Since surgery it's crept from 90 to 104 & he feels so drained and lethargic, is breathless with aches and pains.GP says he needs hb to be at least 120 to feel better...He had a transfusion immediately after surgery.
he's eating lots of iron rich foods and taking supplements but it's taking along time to rise to normal levels.
His ferritin is 149 & B12 150
Anyone got and ideas/experience why it's taking so long to get back to normal?
Poor thing is getting fed up now.

It takes a long time to raise your Hb that much - raising his Hb from 90 to 104 is a good increment already and don't forget he's also getting over the heart surgery.

The transfusion only lasts a month so effectively that's completely worn off by now so he's doing really well to still have maintained a rise in his Hb even though the transfusion is long gone.

Unfortunately it just takes time. He is doing really well.

Just checking - by iron-rich foods you do mean meat and not spinach? You have to eat a phenomenal quantity of leafy greens to get any meaningful amount of iron out of them.

Thanks so much for your reply. He eats meat every day, chicken, beef, liver etc
he's not a big veg eater but eats cabbage and watercress and eggs. He drinks no caffeine.
I've told him to drink orange juice but he's not keen!
He's only in 1 iron tablet daily now. He was originally on 3.
Do you think he must have lost lots of blood during surgery to have such a drop in hb? The surgeon didn't mention it.
(I appreciate you may not know this

B12 very low, possibly because it has been depleted by the anaesthetic. His GP really needs to address that and get it up to at least 500.

That will certainly improve the way he feels.

Oh that's interesting pleasmrstweedle nothing was mentioned about the b12 but I knows that has been low before due to previous issues.

Does he drink tea after meals? It has been shown to inhibit iron absorption, so he needs to wait an hour after eating before drinking tea.

I found this as well:

• Phytate found in the bran of wheat, oats, maize and other cereals strongly inhibit non-haem iron absorption by interacting with it, rendering it less soluble and thus less available for absorption.
• Calcium appears to interfere with the absorption of iron, , although the mechanism is unknown.
• Phenolic compounds found in tea, coffee, red wine, some leafy vegetables, nuts and legumes are responsible for the inhibition of iron absorption. It appears to be the galloyl group in these compounds that is responsible for the inhibitory effects.

He doesn't drink any tea or coffee. Just tonic water or lemon tea and occasionally diet coke.

His ferritin is normal but it is an acute phase protein so goes up in infections and inflammation. New guidelines say if you think iron deficient and the ferritin is normal you need a FASTING iron and transferrin levels. I can't remember the full details as these guidelines have just been drawn up where I am to stop referring people who aren't iron deficient.
b12 is low also what is his kidney function like? Kidney failure can cause anaemia.

Thanksmusical nobody has mentioned kidney function, either before or since surgery.
I know his CRP is now 22 down from 70+ after surgery.
He's had problems previously with low b12 after having Gulliane Barrě 10 years ago

Surgeons don't tend to mention losing lots of blood if the amount of blood lost was normal to them!

Probably the easiest thing would be to go back to twice or three times a day iron tablets for another couple of months. Everything is heading in the right direction but he's been hit by the extra challenge of the transfusion wearing off just as he dropped his iron tablets.

I do find it strange why the GP dropped the iron supplement dose when his hb was so low. I've told him to make an appointment to see her.
He is just fed up with feeling so tired all the time.