Iron tablets - how many mg?

[Zimunya]

DD's ferritin level is 36, which her doctor says is not outwith NHS "normal" levels. But she has all the symptoms of anaemia:
tiredness and lack of energy
shortness of breath
noticeable heartbeats (heart palpitations)
paler than usual skin
headaches

She already takes 14 mg iron tablets per day, and was taking that when she had the blood test which showed the ferritin levels of 36. I want to increase her iron tablets, but how much is too much? Can anyone let me know where I can find this info?

Following as my ferritin level is 39 and been told I’m ok but having all the anaemia symptoms too

If you have funds I'd think about a private iron infusion.

Will this help, though? My understanding is that Iron is a mineral present in red blood cells that carries oxygen to cells in the body. Ferritin is a protein that stores iron and releases iron when the body needs it. So the transfusion will be helpful as a one-off but as that runs out she will be anaemic again, because she doesn't have enough Ferritin?

I take ferrous sulfate 200mg tablets. One per day.

I take 630mg per day. Severely anaemic last year my ferritin is 54 now up from 5 at its worst. Also had iron infusion and blood transfusion last year.

14mg won't make the slightest of difference I'm afraid

There's lots of different types.
I take Iron bisglycinate 28mg every other day because there's some evidence absorption is better EOD (but that's a disputed finding).
It's a bit gentler than some.
Be VERY aware that for non heme iron to be absorbed you need to take it with vitamin C BUT without anything else (no food within several hours each side, don't take other vits at the same time). (Non heme iron is all the ones except the rarer more expensive ones that come from meat sources). Doses of Iron Bisglycinate is a bit lower than some of the others.

Yes this. I’m currently on 9 and NHS are talking about iv infusion/ blood transfusion.

From research the body can only convert a certain amount to blood per month. 200mg I believe.

Im on 210mg daily prescription but cant take consistently due to bad constipation and sickness.

So I am doing every few days and aiming for consistently black poop.

Look up iron points as well as they are helpful. Everyone says eat spinach etc. but that doesn’t cut it if you look at iron points (2 points per serving). Really you need to be eating liver pate and black pudding (20-30 haem points per serving) and fortified cereals are good for non haem.

Basically it’s a right complicated faff. You also need to take orange juice or other Vit C foods to actually enable the uptake. And balance haem and non haem.

Im considering a private transfusion but it’s c. £750.

I take 210mg of ferrous fumerate a day and have been for a year or so to get my level up. Take with vit c and no other food.

I’m on 210mg ferrous fumerate permanently for chronic persistent anaemia (related to lupus).

Thanks for all the replies - much appreciated. Okay, clearly 14 mg is not nearly enough! Consensus seems to be 210 mg. But how do you know when it's too much?

This is what you need to be very careful of. Having too much is just as dangerous as not enough. I would be pushing for a second opinion and say you’d like to try some prescribed iron for her.

I take 600mg a day - on prescription.

My Ferritin was 12 in October, got put on Ferrous Fumarate and had to take 2x 210mg a day for 10wks then I've been on 1x 210mg a day since. I had another blood test on the 31st December and my level had gone up to 62.

I take it with a glass of orange juice and don't have tea/coffee or anything with milk for at least 2hrs either side.

I just have repeat bloods every 3 months to check it's not too much, (fat chance!) honestly, it takes about a year to build up and your body can only absorb so much therefore you'd be hard pushed to overdo it in a short period of time.

Oh and no caffeine for 2 hours either side of the supplement for it to absorb properly x

You can get them on line, I get mine from Medino who are very good. Cost about a fiver for a big pot (sorry can't remember how many, will look when I'm home)

I’m in Scotland where prescriptions are free, but than you for taking the time to offer advice, very kind of you! 😊

200mg ferrous fumerate once daily or 210mg ferrous glucinate daily. Reduce to every other day if side effects (nausea/loose stool/constipation common).

30 odd is classed as borderline, if symptomatic I would ask GP if can trial iron supplemtation as above with repeat bloods at 12weeks to check ferritin levels increasing.

Thanks for this. I will ask for a second opinion, but not holding out much hope as GP was very clear her levels were within normal range. Had no explanation for the dizzyness, faintness, heart palpitations and headaches though - which is very frustrating for all concerned (except the GP - who is totally unbothered!) I don't mind paying for them - that's absolutely fine - but it's so hard to know what the correct dosage should be without input from medical professionals.

www.esht.nhs.uk/wp-content/uploads/2020/12/0872.pdf

Do you know why her levels are so low?

Mine was massively heavy periods.

I paid privately because I felt so ill. I think you should not discount it. It will bring her levels up much faster than tablets and then you can work on supplements after.

@SeatbeltExtender - yes, heavy periods. So the problem is likely to continue for a while.

Thanks to everyone for their help and advice.

I am not a doctor, but I understand you would be unlikely to be giving her too much if she has low iron. I have bought 500mg off the shelf before, so I believe that is a safe dose. 200 easily sounds fine. 14mg is barely anything, so not surprising it has no effect.

After my last baby they put me on 1000mg per day I could only get them on prescription which was a faff so I just bought the 500mg and took two.

Have just seen while looking for something else that doses over 10mg/kg body weight are where you start to see temporary problems with iron toxicity. Higher doses than this can be dangerous.

So if she weighs 40kg for example, then not to take more than 400mg. You could also halve this in order to be even further from any worrying dose. Having read back through the thread, you haven't said how old she is - I am assuming older teen/young adult - but that would be worth checking anyway.

I am a bit alarmed at this, because I definitely don't weigh 100kg! Though it seems that they only get really worried when someone has taken more than 40mg/kg, and my 1000mg dose was less than that.

I take 630mg per day and only weigh 50kg, should I be worried then ...the GP advised and I have regular 3 monthly blood tests.

OP is your daughter old enough to have a mirena coil fitted?

This is my supplement - so this wouldn’t be enough at all?