Sudden anaemia in teenage dd

[Pleasedontdothat]

Dd (17) has been having regular blood tests because of medication she’s on. Everything’s been fine, apart from the last test showed a sudden drop in her iron levels, below the threshold for anaemia, when previously she’d been well above it. Her consultant asked for the blood test to be repeated in case the first one was a mistake, but her latest results show her iron levels have dropped even further. DD’s on the pill (necessary for the other medication she’s on) so her periods are very light so it can’t be that. She has been very tired recently and has had a few spells of dizziness but I’d put that down to stress/anxiety (she’s recently been diagnosed with ASD).

Any ideas what could be causing this? Her consultant has referred her to haematology and has asked us to go to the GP on Monday but I’m now facing a weekend of worrying and want to avoid googling ...

Is she on Roaccutane? Asking because my dd is on it and has to be on the pill and have regular blood tests. It may be to do with that. It can affect all kinds of blood levels.

She is but according to the dermatologist, roaccutane doesn’t affect iron levels - also it’s the second course she’s had and her blood tests were fine all the way through the last course

Bump - anyone? She’s had more blood tests today. GP said the usual causes are heavy periods or poor diet, neither of which is the case with dd. Her haemoglobin levels have almost halved since this time last year, but nothing about her diet, periods etc has changed...

Tiredness and dizzy spells are identical to my daughter's symptoms when her iron is low. Hope she feels better soon.

Thanks - there’s no doubt her iron levels are low - what’s worrying me is why they’re low - it’s not heavy periods or poor diet and nothing has obviously changed since this time last year when her blood results were all gloriously normal. @toothgenie do you know what’s causing your DD’s iron levels to be low?

To clarify, it’s her haemoglobin levels which have dropped and her red blood cells are very small. Iron levels and full blood count are being done now

Coeliac Disease?

Or another cause of not absorbing Iron?

Thanks - I think that’s m one of the possibilities she’s being tested for - I’d always assumed there’d be other symptoms though? I know when my friend was diagnosed with coeliac disease a few years ago, she’d been having awful diarrhoea for weeks

I am certainly no expert!

Although from what I have read, there are a wide variety of possible symptoms and people can have all or even none of them and be diagnosed with Coeliac so it is a definite possibility.

As I understand it diagnosis is not an exact science.

Do you have any family history?

Depending on blood results they may try Iron supplements and retest, a fairy quick and easy way to check absorption. Although lots do not like taking Iron Tablets due to side effects, as they can be harsh on the digestive system. Less harsh supplements tend not to work as well though. Cross that bridge if you come to it of course.

Hope you get some answers and your DD is feeling better soon

Bump! I’m really worried now... the referral letter has come through for the haematologist. DD’s haemoglobin is 84, her MCV is 68 and her iron levels are 3. She’s just turned 17, very light periods and no internal bleeding that she’s aware of. She is vegetarian but eats a good, varied diet with lots of iron sources (and the rest of us are eating the same and are all fine). Her blood counts this time last year were completely normal. She’s very tired, looks pale and has been having dizzy spells. The GP has started her on iron tablets but I’m extremely worried about what could be causing this. Any experience?

This time last year her haemoglobin was 140 so a massive drop ...

How long has she been vegetarian? I am, and have to take iron supplements as I don't absorb plant based sources of iron.

She’s been vegetarian since birth and was having regular blood tests last year when her haemoglobin levels were 140. She also had blood tests for something unrelated in 2016 just before her periods started, which also showed completely normal levels for everything. I can’t see that her diet would be absolutely fine for 16.5 years and suddenly not provide her with enough iron?

She needs to be tested for Coeliac Disease.

I agree @Pleasedontdothat, it doesn't sound like her diet then. Good luck, I hope you find out what it is soon.

@Fairylea your dermatologist might not be aware that Roaccutane (Isotretinoin) has been linked to causing coeliac disease especially if preceded by courses of antibiotics. Did she have antibiotics to try to treat her acne?

www.ncbi.nlm.nih.gov/pmc/articles/PMC4241118/
and
www.ncbi.nlm.nih.gov/pmc/articles/PMC4544877/

I believe you should reassess the benefits of Roaccutane as the harm could be a lot worse .

Such a drop has an external cause and not just a dietary one.

Still has she recently started drinking tea or coffee with meals or within two hours before or after. Tea and coffee block iron absorption.

Is she taking any herbal supplement for whatever reason? Curcumin / turmeric is a potent iron chelator (removes iron from cells) and there are several more natural chelators even if not as potent.

Sorry @Fairylea, post was meant for the OP @Pleasedontdothat.

Yes @LeGrandBleu she had several courses of antibiotics before starting roaccutane

I’ll read those links now, thanks

She doesn’t take any supplements, doesn’t drink coffee and only has tea occasionally

Hmm neither of those studies shows any association between isotretinoin and coeliac disease, but the first found a slightly greater chance of people with acne developing CD?

She would be devastating to have to stop roaccutane as it’s the only thing which has helped her skin

"Albeit not statistically significant, isotretinoin users were at a 22% increased risk of CD. "

I agree there may be a problem with absorption. Coeliac is more likely but my DD was 15 when diagnosed with crohn's disease and first symptoms were fatigue and low haemoglobin. Took 6months of tests before referral to gastrointestinal specialist to diagnose.

I was vegetarian for 20 plus years and could never get my iron levels in a good range despite eating copious amounts of spinach. Also vitamins are not a replacement for a good diet.

There are two different types of iron - Heme (animal sources) and non-heme (plant based sources). Humans struggle to absorb iron from plant based sources unfortunately. Lots of people can cope but lots can’t such as young women, pregnant women, children etc. Perhaps a veggie diet isn’t the best thing for her at the moment.

She won’t eat meat so not being vegetarian is a non-starter - nothing about her diet has changed so it doesn’t make sense that her iron levels would be gloriously healthy for years and then suddenly plummet in the last few months.

PS spinach isn’t actually that great as a source of iron, but she has plenty of foods which are

What foods does she eat that are high in iron?

Given her history of previously normal results I think her diet is extremely unlikely to be the cause.
Roaccutane can cause anaemia and this needs to be considered.

bnf.nice.org.uk/drug/isotretinoin.html

How soon is she seeing haematology?

Hope you get this sorted asap.