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

I don’t think you need to wait as long as 3 months before checking back in with a different doctor

If it helps I take a fizzy vitamin C like these

amzn.eu/d/cPJy5N9

Make it up, and then take all my meds including my iron with it, seems to really help absorption

The most likely to cause digestive issues, and least well absorbed. You've had so much good and detailed advice on here...🤷🏻‍♀️

I'm following some of the advice on here and people have stated ferrous fumerate is the one most likely to cause stomach issues.

For those that struggle with the side effects, spatone is really very good. Yes it ‘contains’ a very small amount of iron but it is very well absorbed. The ferrous salts (eg sulphate) are not as well absorbed hence you need to take higher doses. It is worth trying a few different ones and seeing what works for you. I ended up taking things into my own hands and get thriva iron tests every 6 months or so. But it comes with a cost. Like you OP the GP didn’t seem to understand what ferritin was and thought a level of 12 was fine when I was very symptomatic.

They all look normal. Ferritin at the very lower end of normal though and serum iron and transferrin saturation is a better indicator of iron stores. You are not anaemic.
Are you on folate?

My Gp has told me to continue my perimenopause supplement daily and top up with a sachet of spatone daily for my low Hb and MCH (ferritin is 16).

GPs and other healthcare professionals used to be very eye roll about spatone as the ‘content’ of iron is low but are more encouraging about it now because it’s a very gentle and highly ‘bio available’ form of iron. It’s dragged my Hb out of my boots every single pregnancy alongside dietary changes, lots of dark leafy green veg, strictly no caffeine drinks (tea coffee etc) an hour either side of taking it, a glass of freshly squeezed orange to take it with.

I am also mostly vegetarian (because the rest of the household are) but I’m going to convince the DH he needs to take me out for a steak 😉

I hadn’t noticed my nails are awful at the moment and I’m losing a lot of hair, hadn’t even linked it to perhaps my iron is low!

This thread has actually made me feel a lot better, I’m hopeful getting my Hb and ferritin up is going to curb these horrible symptoms because I’d started to worry I had something really wrong neurologically with the double vision etc.

Not on folate. I did wonder about that too as it is higher. I take vitamin d, magnesium, iron, and evening primrose.

I eat a veggie diet, high in pulses, fruit, veg, nuts, tofu. Try to cook and freeze. Do eat a lot of cheese and greek yoghurt but now ready dairy isn't good for low ferritin?

I feel awful with low ferritin. I'd consider yours to be very low.

I'm going to fiddle around with what I take and see what I can tolerate and then just pay for some tests to see if it rises. If I still feel like a zombie after a month or so, I'll go back. It's the joint aches which get me, too. Sometimes when I get up I look like an elderly person. My mother has horrific osteoarthritis and my grandfather had rheumatoid arthritis. I did ask about the lack of inflammation markers in the blood because people with arthritis can sometimes have no markers, but I was told because I had no swelling, I was all fine.

I'll report back on how I go in case it helps others. May just be bloody peri.

Definitely iron as others have said, make sure you take one with orange juice to help Absorption as it's not easily absorbed, and Vit D (but you take anyway)
Don't happen to eat fish or would you consider this?
I also think peri menopause, especially with the aches too. I took a POAS test from Amazon, perhaps try this ?
Good luck

I'll look for a POAS test and read up about it. Thank you.

@lovecrazyhorses Not anaemic no, but definitely iron deficient. The WHO defines iron deficiency as ferritin less than 15 µg/L and iron deficiency without anaemia would explain OP's symptoms. Iron deficiency without anaemia is common in menstruating women and, honestly, with a ferritin of 11, supplementary iron can't hurt, before it turns into frank anaemia, especially if there is still heavy bleeding going on.

One more thing to consider is Lyme disease,

but I agree with others that iron levels and/thyroid issues are more likely

Of course but better to check serum iron and transferrin saturation for accuracy

My money would be on the low ferritin, been there myself. Are you having horrendous periods?

It's going to take time to sort out but you need to reduce/stop the bleeding and supplement with iron as well.

As said before it's definitely your iron levels!! You will feel all kinds of symptoms below 70 or even 100. Last time mine was less than 5 (they couldn't read it) and I had such crippling anxiety/dizziness from it u was ready ti commit suicide. They are still low and I still don't get taken seriously so my life is quite miserable. Definitely out your foot down about getting a prescription if you can x

It is your ferritin! Check out the Iron protocol on FB. I was feeling terrible....fatigue, muscle aches, headaches etc. Found out my Ferritin was 12 and GP said it was too low. I did further research and it seems many get symptoms if ferritin goes low, but doctors do not seem to be aware of this and there are different thresholds for what counts as low....since I started taking iron I am feeling much better (took a few weeks).

@SamPoodle123 I’m glad you’re feeling better after taking iron supplements. I agree that it’s frustrating that the ranges for low ferritin differ in different labs.

I posted earlier about the Iron Protocol Facebook site. I’m sorry to repeat myself but it’s a source of huge disinformation and I would strongly recommend people get advice from more credible sources. The sites advocates for taking huge amounts of expensive haem iron supplements, is run by someone who has no medical, scientific or research background and who offers user discounts and affiliate links to haem supplement companies.

Iron deficiency is awful, and it’s understandable to seek info online when you’re feeling so bad. This is especially the case when you’re iron deficient but not anaemic- meaning GPs won’t investigate further.

Just to say that you don’t need a prescription for high strength iron supplements. If you don’t have pre-payment or exemption, it is cheaper to buy them over the counter. 210mg/320mg ferrous fumerate is what doctors would prescribe.

My only caveat would be to say that if possible, it’s worth staying within the GP system when starting iron supplements. That way they can monitor to see if they are effective. If you are taking high strength iron and your HB doesn’t improve, the doctor will want to do further testing to find out the cause of your anaemia.

Unfortunately, doctors look at the HB first and if that’s in range then there is no formal pathway for them to start addressing iron deficiency. A lot of GPs are sensible, and will treat iron deficiency without anaemia - but it’s on a case-by-case basis.

As I mentioned before - this chronic fatigue so many of us are going through is often caused by many factors. My advice is to talk the doctors about your symptoms rather than your suspected diagnosis. And consider changing GP surgery if necessary. My care has been transformed after moving surgery. I can consistently see the same doctor who has an appreciation of the many factors involved in how bad I’m currently feeling.

Very best of luck to everyone on this thread. And remember that iron supplements can take a while to work. Even when your numbers rise into the normal range, clinical guidelines are to keep supplementing for a further three months. It’s a long game - and not a fun one.

The heme ones which were 18mg a day and got mine from 24 to 65 in 6 weeks when they re-tested were called OptiFer and they are quite expensive, about £33 for a months supply, I also have used and been recommended Hemaplex it is non heme.

With non heme it is meant to be best to take them on an empty stomach and with vitamin C so e.g. small glass of orange juice. Hope you get it sorted OK!

They can still rest and monitor if you take your own ones, I found (just asked) but the NHS ones are high strength and free (on prescription anyway) or OTC very cheap.

I had to avoid those as I have a bowel condition and they might have been a bit strong and can cause constipation though.

Have you considered ME? Your symptoms sound typical and blood tests are normal with ME.

I'll see if there is a change with supplements.

My aunt has CFS and Crohns disease.

yeah - the constipation is real 😳