Are they being over the top sending me to a consultant in haematology?

[ItsMyLastOne]

I'm 18+5. My iron levels at 12+ weeks were 8.8 (I had been taking 200mg iron a day up to then). So I was then taking 600mg a day. My iron levels at 17+ weeks were 9.2. Then this week I got a letter saying because it hadn't improved much I have to see a consultant in haematology in a couple of weeks.

In my last pregnancy my iron levels were between 9-10.5 throughout, until reaching 11 at the very very end. No one fussed about it then, just told me to keep on the iron tablets.

FWIW my iron levels are always low so it doesn't seem much of a big deal for me.

Why the big hoo haa about it this time? Someone please enlighten me!

Hmm, when was your last pregnancy? With dd (almost 2) I was referred to consultant & had an iron infusion. With DS almost 5 I was told to just keep taking the iron tabs. This time was 8.9 at booking, being retested at 22 weeks & if still low (it will be, always is!) will be another iron infusion. So might be a time lapse thing or maybe because it dropped below 9 or something. MW should be able to tell you. There's a few risks that can come from being anemic while pg that they'll just want to get you all sorted. :)

If you suffer from chronic anaemia it would be a good plan to discover why, and treat you if possible.

It isn't great for you to be so anaemic in pregnancy. God forbid that you might have a post partum haemorrhage, but if you did, and you were anaemic, you would be less likely to survive without blood transfusions and drugs.

It sounds as if they are taking good care of you.

The normal range is about 12-16 for an adult female, but this drops during pregnancy to 10/11 ish. You are on the low side, and it is right that they are investigating (I think, but am not totally sure, that the threshold for investigation is 10.5).

This is done because there can be associations with underlying conditions, and there is a known increase in statistical risk of poor outcome in anaemic mothers. It is a good thing that they are following best practice.

Thanks for your replies.

debdee my DD is 21 months so it hasn't been that long. But having said that, there do seem to have been a lot of changes in how other things are done since then, so maybe this has changed too.

I've always been anaemic but apart from when it's got as low as 7/8ish and when I've been pregnant I never bother taking iron. It just makes me so constipated (this time I've been given lactulose to help that) so unless I absolutely have to, I just don't choose to take it. I've never had any investigations as to why I'm always anaemic. It's never even been questioned, I've just been given prescriptions.

During my labour with DD I did lose quite a lot of blood, but it wasn't recorded as it was mostly on my bed, sofa, stairs... you get the picture! Then my iron level the following day was 8.2.

I know there is a risk of needing a transfusion if I have a PPH but it just seems very early to be seeing a consultant considering I'd only had the higher dose of iron tablets for less than 2 weeks before being retested.

What other risks are there with being anaemic? I've never had anyone explain any of this to me so I'm totally unaware of it all.

It would be good to work out the reason behind the anaemia- I was anaemic for a long time and it turned out I have coeliac disease. Not sure bout risks to baby though- sorry!

I have coeliac disease too but no one's ever mentioned a connection. And being on a gluten free diet for 6 years has improved my anaemia. Did it improve for you after you found out?

Sorry hasn't improved my anaemia! Oops!

I had very low hb levels prior to diagnosis and ended up having a blood transfusion. Since going gluten free it's now settled and is in the normal range. I've been taking iron tablets during pregnancy though but my hb has still dropped but not too low- 10.9. Had your gastro consultant not looked into your anaemia before then? You must be feeling very tired!

I only saw a consultant twice IIRC. One before a gastroscopy and once aftewards. But that was 6.5 years ago. I've never seen anyone about the coeliac's since. It has only come up when I've been asked about existing medical conditions when pregnant.

I do feel tired all the time, but my DD still wakes a couple of times in the night and being pregnant, I don't know whether I'm any more tired than anyone else would be. I suppose it's hard to know how it feels to not be anaemic as I always have been like this. I think my record iron levels were 11.5-12, definitely no more than 12. I do sometimes wonder if I'd feel any better if I had normal iron levels.

In my last pregnancy I had to see a doctor because apparently coeliac's is linked to gestational diabetes so I had to have a GTT. It was all normal. They never talked about anaemia being associated with coeliac's - how strange!

I'm amazed they haven't followed you more closely. Now my hb levels are fine I can def tell the difference to my anaemia days! I used to want to curl up and sleep all the time and often felt out of breath. It became normal to me so I didn't even realise there was a problem until it became severe. Sometimes the villi don't recover 100% which may explain the continued anaemia.it's good they're following it now. Interesting about the gestational diabetes as I haven't been tested for that. Did you have a problem with weight gain pre diagnosis and, if so, is that better? I hope they sort out your anaemia soon as I'm sure it'll be making you so tired.

I didn't struggle with weight gain as such as I was a healthy weight (probably about 8-8.5 stone) but I did notice after a while of being on a gluten free diet that I found it easier to put on weight IYSWIM so I had to take more notice of how much and what I was eating.
I was 8 stone 5lb when I fell pregnant with DD 2.5 years ago, and about 9 stone 2lb when I feel pregnant this time.

I do feel very tired a lot at the moment. For example I'm sitting here trying to type up invoices but keep typing numbers wrong, and I'd quite like to just go and close my eyes!

Think invoices are likely to send anyone to sleep!

No I think it's a sound plan and one of the benefits of being pregnant - suddenly you can see people you would normally need 50 gp trips and a 6 month wait for.

Go for the review, in the sure and happy knowledge that you have had a problem free pregancy and birth and will do the same again. For your own general health, having a reason for this would be good.

If your iron levels went from 11 to 8.2 after your last birth that's indicative of a pph of close to 3 litres!

It can't be good for you to be so anaemic all the time. You've probably got used to how it feels and cope with it quite well but i think you'd notice the difference in energy levels if it could be sorted.

I hope this consultant can help then, other than just telling me to keep taking the ferrous sulphate.

I wonder if he/she will have details of my anaemia last time, I'd presume so. Do they keep your old notes when they take them from you after birth?

3 litres Viva really?! Isn't that a lot? How did you work that out? No one mentioned the big drop in iron levels, apart from to say it was a bit low afterwards and to give me yet more tablets. The 11 result was taken 2.5 days before the 8.2 result and I spent the whole time in between in labour so I doubt I took any iron tablets then, so it might not have been just the bleeding that caused the drop. Although it did seem like an awful lot of blood and DP was NOT impressed to have to clean it up! I would have loved to see his face doing it, I used to bleed everyday pre-pregnancy and he'd often heave after sex with just a small amount of blood, er, on him! Anyway, I might ask about that bleed when I see this consultant, so thank you.

Its generally accepted that as a rough indicator for every litre you lose in childbirth your Hb will drop a whole digit. I don't think that not taking your iron tablets for 2 days will have contributed to the fall much as it takes a lot longer than that for levels to fall without blood loss.

If I've got someone and we've estimated a 2 litre blood loss at birth and her Hb is checked and say it was 10 to start with and her HB comes back at 8 we know we've accurately estimated blood loss. If her Hb came back at 7 I'd be thinking she'd lost nearer 3 litres.

In theatre where we are very accurate as we weigh all swabs, etc so we can get a very good picture of blood loss the drop in Hb of a whole point per litre is very true.

And 3 litres is a lot - its about half your total blood volumne. However if you've been used to running at a low Hb then you'd have coped with that a lot better than someone who normally has a Hb of 11.

I am anaemic and found out last march atfer i had burst blood vessels on my leg went to the GP and found out my levels were 8.5.
I had headache every day, tired everyday, breathless quite a lot, I just thought it was normal as have 2 dc and always running around ect ect. Anyway 15 months later my levels are just under normal range at 11.8 and my life is transformed hardly ever get headache and don't need a sleep everyday!
I have been taking spatone which is a natural form of iron I have two sachets every morning it costs me £15 per month but its worth it!

Wow, that's really interesting Viva thanks. They estimated a 500ml blood loss, but by the time I was let in I was 7cm and had already lost loads of blood. I did also bleed everywhere in my mum's car, on the chair the porter used to wheel me in (he didn't look impressed!), in the room, in the bathroom, just everywhere! But they did say they could only record what blood loss they'd seen themselves.

ELR I've actually been to the mw because I've had a headache every day now for 5 weeks, it's driving me mad! She just said it was one of those things, but didn't mention my anaemia being a possible cause for it.
Where do you get spatone from and can you get it on prescription?