Blood test results and GP no idea

[Icenii]

Below are my blood test results. All apparently normal. I have been feeling persistently tired, with some days of total exhaustion and brain fog. In addition, some days I am extremely stiff in my joints, and my muscles ache. I have no joint swelling. I assume peri (46). The GP stated there is nothing in my blood to indicate an issue, and it is unlikely to be perimenopausal. He was rather dismissive and finally agreed to see me in a month. They seemed more focused on mental health issues.

Is there anything obvious below?

Rheumatoid factor 8 Range: Below 12.5

Serum ANA level Negative

Tissu transglutaminase IgA lev < 1 Range: Below 6

Urea and electrolytes
Serum sodium 138 Range: 133 to 146
Serum potassium 4.5 Range: 3.5 to 5.3
Serum urea level 3.0 Range: 2.5 to 7.8
Serum creatinine 55 Range: 60 to 120

eGFRcreat (CKD-EPI)/1.73 m2* Range: > 90

Liver function test
Serum ALT level: 11 Range: 10 to 49
Serum bilirubin level: 10 Below 21.0
Plasma C reactive protein < 5 Below 10
Serum urate level 309 Range: 184 to 464
Serum total protein 76 Range: 57 to 8

Serum vitamin D 63
Serum vitamin B12 524 Range: 220 to 700
Serum folate > 20.0
Serum ferritin 11 Range: 10 to 291

Full blood count
Total white cell count: 7.9 Range: 4.0 to 11.0
Red blood cell (RBC) count: 4.89 Range: 3.90 to 5.60
Haemoglobin estimation: 147 Range: 115 to 165
Haematocrit: 0.447 Range: 0.370 to 0.470
Mean corpuscular volume (MCV): 91 Range: 80.0 to 99.0
Mean corpusc. haemoglobin(MCH): 30.1 Range: 27.0 to 32.0
Platelet count: 334 Range: 140 to 400
Neutrophil count: 5.34 Range: 1.50 to 7.50
Monocyte count: 0.42 Range: 0.20 to 0.80
Eosinophil count: 0.04 Range: 0.04 to 0.40
Lymphocyte count: 2.05 Range: 1.00 to 4.00
Nucleated red blood cell count: < 0.20 Range: 0.00 to 0.20

Serum LH level: 12.1
Serum FSH level: 15.8

Haemoglobin A1c level: 4.9 Range: 4.0 to 5.9

HbA1c levl - IFCC standardised 30 Range: 20 to 41

Serum free T4 level: 12.9 Range: 11.5 to 22.7
Serum TSH level: 1.00 Range: 0.55 to 4.78

Peri meno. Blood tests don't prove peri or otherwise. HRT should be prescribed on symptoms. (it's in the nice guidelines).

Go back and see a female GP or a male GP who knows what he is talking about.

Ask for a HRT trial and don't forget to ask for some vaginal oestrogen cream.

He said if my periods were regular, unlikely peri. I'm assuming that is incorrect.

I would say that this could be definitely contributing to how you’re feeling.

Serum ferritin 11 Range: 10 to 291

Ferritin!!!!
it should be around 70 minimum.
and perimen don’t help either, but start with ferritin.
i buy Ferrodyn off Amazon and read up on how to take it properly x

Shouldn’t the blood test include oestrogen and progesterone and testosterone?

Yes, you are low in iron. Take supplements and call your GP. They are meant to prescribe you a type of supplement when you are low.
This is not the first time I hear of someone being low in iron as per analysis and the GP does nothing about it. Anyone knows why is this? I mean, it is a really simple one. Test, supplements, re-test, if persists, check diet/ other issues.

You might find this website helpful
https://theironprotocol.com/

How any GP can tell a woman with fatigue etc and a ferritin of 11 that her bloods are normal is beyond me. Absolutely negligent.

Basic option is Ferrous fumerate every other day, OP. Can be prescribed for you or bought from chemist. It can cause constipation so if you don't tolerate that buy iron bisglycinate online, sold as 'easy iron'. Again, every other day as studies show that optimises absorption. With vitamin C, away from tea/milk/cereals.

Can also try Better You iron mouth spray and spatone apple.

The amounts of iron will differ hugely in these products but what matters is the absorption. So you will absorb a higher % of the spray as some of the iron in the tablet will pass through your bowel.

You could also be peri but your iron needs sorting out regardless.

Your ferritin is low - the normal ranges are out of date and anything below 70-100 is low.

It indicates you are low on iron and the common causes in women are heavy periods or lack of iron in your diet.

Yes, you probably are peri. However unless you report some classic peri symptoms eg hot flushes, irregular or newly heavy periods, vaginal dryness, your GP is unlikely to think peri. Especially if your GP is a man or a woman who is too young to have been peri. I had no idea peri made your joints and tendons ache until I personally was peri and started looking into it and everything made sense.

From my experience it's because they then push you onto anti-depressants when the affects of anemia hit.

I only found out when I went to donate blood, despite having been told my bloods were fine the month before and put onto Prozac.

In all honesty the NHS guidelines are not the same as other countries and if they don't go officially under the NHS limits the GP won't do anything, doesn't have to at any rate. I personally think for women they need amending and they'd save a lot of ££ on other prescriptions related to anemia.

It’s so annoying when blood tests are all in normal but you feel so rough.

As pp said, the ferritin is the thing that jumps out at me. Even though it falls within the normal range, I feel really awful with a ferritin of 11. Incidentally, different labs have different ranges. So my results say anything under 13 is too low. My GP advised me that I should aim for over 70.

You could start taking iron supplements and see if that makes a difference. It’s worth knowing that it can take a few months to feel the effects. It takes 120 days for all your red blood cells to renew.

There are lots of different threads here about iron supplements. The strongest ones (and the ones doctors would prescribe) are ferrous fumerate either at 210 or 320mg daily. You can buy them online without a prescription. A lot of people find they can cause tummy issues. I take them every other day and have got my ferritin up to the 40s in three months. I use an oral iron spray on the days in between.

Good luck. I’ve been in position and the one thing I feel is that (for me) it’s not just one issue. I’m post menopause but can’t take HRT, poor mental health, low iron, recurrent bugs and post viral things which have features of long Covid (especially PEM).

Ferritin is not great at 11. I couldn’t stomach iron tablets until I found Iron (ferrous) Bisglycinate. You will feel tired with a level as low as 11. Mine was 3, getting it retested next week but definitely feel a bit better after a couple of months on this.

Agree - ferritin shows significant iron deficiency.
I use iron bisglycinate as has the fewest side effects for me. I take with 1000mg vitamin C on waking every day. It is best absorbed in the morning and on an empty stomach. No tea, coffee, milk, egg, within an hour or so. I will be adding in spatone and vitamin C again later in the day but find it very hard around tea/coffee/food.
some iron brands will give a high dosage eg 210mg but absorbability is actually very poor.
try and get heme (animal) iron into your diet too eg beef and chicken liver.

I think one reason is because iron is usually low in women and waved away as 'just due to menstruation'.

I was told all normal with a ferritin of 8. Another, more enlightened, GP saw it and said he was surprised I was still upright.

A practice nurse told me she was endlessly trying to educate the GPs, especially the older ones, not to ignore ferritin.

Lab ranges do vary, but a lower level of 10 is unusually low.

3!! In Australia my GP was horrified I was at 6 and sent me for an iron infusion. They are ridiculously hard to get in the UK, but has it been mentioned?

Thecadvice given on Iron Protocol is incredibly inaccurate and borderline dangerous.

Your body can only absorb a small amount of iron every day and their guidance to mega-dose is not only pointless, but actually harmful. When you take large amounts of iron, your body produces a protein called hepacadin that blocks iron absorption. Hepcadin is still blocking absorption for up to 48 hours afterwards.

The site is also a huge advocate for heme iron supplements, and makes a lot of money from affiliate links. The safety and efficiency of heme iron supplements has not been proved.

How did you get them to do that many tests? All seem normal so what more do you want?

My ferritin was 3 last year and I was pregnant. I thought I was dying, I was hallucinating and could barely move. I had 2 iron infusions and was a different person afterwards. 11 is low, you need iron supplements.

Dr BumbleBee wading in here oblivious, after a glaring issue has been spotted and OP has been given well-informed and sensible advice... 😂

A ferritin of below 30 is deficient, according to the nice guidelines.

Your T4 is also abominable. If mine were that low I'd be bedbound. Looks like central hypothyroidism, where the thyroid fails but TSH doesn't respond so it's missed by almost all GP's.

Recommend checking out the thyroid forum on healthunlocked the admins are v.v.v. knowledgeable.

Her iron is defiantly not normal!

No, they're all within range. That doesn't mean it's normal for OP.

A size 4 shoe and a size 7 shoe are both normal but if I'm a size 6 neither will be right for me.

I agree with the low ferritin level. I was exhausted, my hair was falling out and breaking off to such an extent the GP referred me to a dermatologist about the hair loss, despite telling me my ferritin was normal.

Long wait for appointment but dermatologist said ferritin was far too low and need to be at least 70 and as near to 100 as I could get it. I was put on ferrous fumerate twice a day and vit D high dose. Took ages for my hair to improve but it did and the fatigue improved . I recently noticed my hair starting to fall out a lot again and bought the same dose of ferrous fumerate online and this time the shedding has stopped after 5 months. I’d definitely ask for a prescription or I bought 3 packs of 84 tabs of 210mg strength tabs off eBay for £11.99.

Yep, I agree about the ferritin. It might not be the whole issue but it definitely won’t be helping.

I went to the GP a few years ago with fatigue, brain fog, pins and needles etc and she found that my ferritin was 4. She was amazed that I wasn't feeling worse than I was - she also quoted something like 70 being the minimum.
Anyway she was very, very good and said the most common cause of low iron in the absence of very heavy periods or a poor diet is malabsorption caused by coeliac disease. And lo and behold, that's what it was!
I didn't have any real digestive symptoms beyond occasionally feeling a bit bloated. It might be worth asking for a coeliac test, @Icenii - it's woefully underdiagnosed and can cause all the symptoms you mention.