Low iron - but why?!

[Curlewwoohoo]

I went to give blood tonight and my haemoglobin is too low, at 113g/l. It needs to be 125g/l to donate. I've suffered from very low ferritin levels before, from memory they were about 6. I was put on iron tablets, but have since wondered why I wasn't given an iron transfusion. I've just dug out my blood test results from 2020 after I'd been talking iron supplements and my haemoglobin was only 126g/l then. Why is my iron always low? I have a mirena coil so no periods. I eat a reasonably healthy diet.

I’m booked in to give blood in a couple of months for the first time, i didn’t even know they check for anaemia.

Yes they check haemoglobin iron levels - hope yours is ok

Ahh that’s good to know. Thank you.

Lots of people struggle to absorb iron, either in supplements or from food.

Vitamin C and copper can both help with absorption, as well as avoiding drinking tea.
Liquid iron supplements, or iron bisglycinate are better too.

I’ve had low iron for years, been on / off iron tablets. Most recently they found out my iron levels were 68 and ferritin 2. They think it’s a gastrointestinal bleed somewhere, waiting for scans. I got a blood transfusion and then an iron transfusion. I think it’s tricky because they just assume periods and hand you iron tablets ( mine are not heavy) unless it’s low enough to be life threatening.

I was checked out for coeliac disease. It was fibroidy heavy periods.

I had a routine blood test recently which picked up low iron.

Not to alarm you - but the GP is being cautious and testing me for bowel cancer, coeliac etc.

I think low iron when you don't have periods (I also don't) with no obvious cause is a cause for further investigations.

Definitely book a GP appt.

How low was yours @intrepidgiraffe if you don't mind?

I was surprised when the GP signed me off as levels being ok and not needing iron supplements anymore in 2020 as they were still very borderline and my ferritin was below 50 still. The GP surgery really didn't seem bothered.

I don't know to be honest - I was just asked to make an appointment and the GP said low iron. If it's relevant the issue the blood test found was small red blood cells - which I think means low haemoglobin.

The thing that seemed to alarm the GP was when I said no periods. So I'd spell that out if I was you. The GP said she's just being abundantly cautious, but I'm pleased she's trying to find out the cause rather than just treat the low iron.

126 is a perfectly normal iron level. It's dropped 13 in 4 years so that's not that bad. Do you take supplements now?

You would only get an iron transfusion in specific circumstances. One of which being that iron supplements don't work, which they do for you. So I would suggest taking some daily to maintain it. You're more than likely lacking in iron in your diet.

NHS state ferritin over 41 is normal, and HB over 114 is normal. So you're bloody results in 2020 were normal

I have been talking supplements but only weak ones not ferrous fumerate. I would be really very surprised if my diet is lacking in iron.

Our GP tried to get my DD an iron transfusion a couple of weeks ago as her level was 74. The hospital said the cut off for them to consider it was 70.

Interesting, because you wouldn't be able to give blood with these levels! I've also read elsewhere that ferritin needs to be over 50 to feel well.

This whole 'normal' thing drives me mad. It's so subjective. My ferritin is best for me around 90, I was disintegrating last year when it was 5, it's now 30 which yes is above the very wide NHS lower limit but in no way do I feel good.

Are you in England? My dd was refused a transfusion when her ferritin level was 4! After a few months of high dose tablets her level is 25 and her GP thinks this is now all fine 😐

the blood donation service need donors to have a relatively high starting Hb because they're removing blood. Most people can function adequately with an Hb a the low end of the normal range, but if you then remove a dollop of blood by donating it that may tip someone over the edge into being symptomatically anaemic. The other main scenario where the 'normal' Hb target is usually higher is if you're having major surgery.

There seems to be a bit of confusion on this thread re. haemoglobin/ferritin/iron levels, all of which are different things. There is generally more respect these days that the lower end of the 'normal' range for ferritin, even with a decent haemoglobin, is too low for some people to feel completely well (but equally, some of people are fine with apparently low iron stores).

Re iron tablets vs infusion. Many people respond well to oral iron, particularly since the dosing is generally lower these days than it used to be and therefore the side effects a bit less dramatic. For people who don't respond well to or can't tolerate the side effects from oral iron, or for whom there's a degree of urgency in getting the numbers back to normal (eg. ahead of major surgery or childbirth etc) then IV iron may be better. IV iron does come with some risks/side effects too though so there has to be a discussion about relative pros & cons. Blood is not used to treat iron deficiency alone, it's used in response to severe/symptomatic anaemia, with the triggers for transfusion being slightly different in different contexts.

The normal range for Hb for women goes down a bit lower than for men reflecting the monthly bloodletting that a lot of us do. However, if a woman isn't having periods and is iron deficient or anaemic then it's worth having a conversation at least with a GP to think about whether anything else could be causing it.

Not being able to give blood does not mean you’re anaemic, it means you can’t spare it. It’s a finger prick test from memory. The blob is supposed to sink and if it floats you can’t give blood. Happened to me once but when I when to gp my iron was fine.
www.blood.co.uk/the-donation-process/after-your-donation/how-your-body-replaces-blood/#:~:text=Before%20every%20blood%20donation%20we,and%20135g%2Fl%20for%20men.

I've gel fine with ferritin under 50. They don't test ferritin when you give blood anyway.
However, the last time I gave blood I obviously passed the anaemia test, but took weeks to get over it so I will never give blood again.

@Sallysoup that was my experience in 2020.

Just checking my blood results from last year - iron was 10.8 and ferritin 21! Yet nobody flagged it… these are way below anyone’s here I think?

113 isn't worryingly low, it's "OK". But if you took a pint of blood out it wouldn't be OK any more.

I'm also always a bit touch and go for iron levels when I donate - not anaemic but I don't have enough to spare a pint comfortably. I just top up with OTC iron tablets and orange juice as and when I remember it and make sure to have vitamin C in some form when I eat red meat.

Sorry I wasn't very clear, that was HB level. Her ferritin is low but not as bad as 4, she must have felt terrible.

If it's the same as my GP then they regard 20 ferritin as 'fine' it's absolutely ridiculous. I felt like death. HG was 83