Anaemia - how low before I get referred?

[Redrosebelle]

I’m 27 weeks, in the last 2 months my hb has dropped from 125, to 113, then 96. I feel awful.
I am on iron tablets but they’re making me throw up. I was already being sick - I asked about spatone sachets but was told they wouldn’t bring my iron up as effectively.
How low should I let my iron levels get before I insist on something else? My colleague was anaemic at 90, and they gave her an iron infusion.
Thanks

Under 100 would trigger a consultant review in my trust. Your midwife would usually review your bloods and make a referral at your 28 week appointment - I assume you haven’t seen her yet? Iron tablets clearly aren’t doing it for you and unfortunately spatone isn’t going to be enough at this stage. If the policy at your hospital is for a lower threshold for consultant review/infusion; I would go to your antenatal day unit or equivalent feeling ‘weak and dizzy’ and they’d have to review you and make a plan from there.

No, I had a gtt a few days back and asked the phlebotomist to also do a fbc. I didn’t hear so I called and someone told me it was 96. Then I had to phone my own gp, who left a prescription with reception. I did say I struggled with them before, he told the receptionist to tell me to take antisickness
I have been feeling weak and dizzy for several weeks, the worst part is the tiredness and breathlessness, I honestly feel dreadful. I next see the mw 5th September.

Have you got a phone number for the community midwife or her office? You could always leave a message for her at the GP surgery if not. Don’t expect an instant call back, obviously it depends how often she works and her workload and then it could take several weeks to actually slot you in to see a consultant. If you are really struggling, it might just be best to ring the antenatal day assessment/triage phone number (whatever you have locally).

I’m having the same problem . I tried ferrous sulphate for three days but it made me have severe diarrhoea and nausea so I had to stop. I’ve switched to spatone and also ferrous gluconate tablets, I bought them from the pharmacy. Similar dosage to ferrous sulphate without the nasty side effects. Three days in and so far, so good. Maybe an option?

I had the same problem in my last pregnancy and felt utterly retched from week 15-40. I got down to 92 at my lowest point and my midwife told me that if I dropped any further then I would be referred to a consultant and wouldn't be able to have the baby in the midwife led unit. I took the iron tablets and had horrible sickness every day with them as well as constipation. Fortunately mine was at its lowest right at the end of my pregnancy so I had the baby before any further action was needed. You have my sympathies. The tablets are grim.

Thank you. Typically it’s a bank holiday and I have an important day at work tuesday but I’ll leave a message for the midwife on Tuesday and see if she can help. Thank you for all your advice and sympathies x

Push hard to get iv iron. It's utterly transformative.

Do you know how low it needs to be before they’d give you that?

I don't know if there is a specific critical cut off. But I'd go in and say I'm exhausted, weak, breathless and cannot go on like this. Anaemia totally ruined my pregnancy. I wish I had stood up for myself sooner. Iv iron is expensive though, so it's not necessarily offered readily perhaps. 15 min infusion and I was so much better within a few days.

Well I’m not going to absorb anything and if spatone doesn’t do the trick I’ll have to have something. I plan on going to the MLU so really need to get sorted ASAP! Thank you for your advice x

If I were you I'd push for an infusion asap as the tablets are useless. I was slightly anaemic before I fell pregnant so didn't start off well. Levels hovered around 110 until about 30 weeks when it fell to 100. I had an iron infusion at that point but it didn't increase my levels at all. Had an ELCS at 35 weeks and a heavy PPH meant I then dropped to 82 and needed a blood transfusion. Whilst the infusion didn't seem to help it could be that it actually stopped me from dropping any lower! Pregnancy tiredness is bad enough but being anaemic takes it to another level. Hope you get it sorted and feel better soon.

Spatone won't be enough. I was taking two or three a day and my iron was still dropping. Just wobble in there and fall on the floor muttering "iv iron". No, really, I am positively evangelical about this because I'm still annoyed that I was left feeling so wretched for so long when the treatment was easy, obvious and swift.

To be honest, I am quite annoyed. I told the midwife 3 weeks ago I was breathless and she said to just keep an eye on it. Then I realised my heart rate was through the roof and asked the phlebotomist at my oral glucose tolerance test do do a fbc. When I phoned for the results the snotty receptionist assured me they’d have phoned if there was a problem. When I insisted on being put through the midwife said my hb is dropping significantly and to speak to a gp. Gp left a message at reception to take iron tablets and antisickness if I need to. Really helpful!
I’m going to go in next Wednesday and get a plan.
Thank you all for being so understanding and not thinking I’m a drama queen!

Is there a difference between ferrous sulphate and gluconate? I've been prescribed the latter automatically. Unfortunately it's given me awful constipation, so I've tried the liquid stuff. I don't think it's been strong enough and I've quickly become pale and tired again so back on the tablets tonight.

OP you're definitely not a drama queen - good for you, persistence paid off.

They are just different iron salts. Some people get on better with one than the others. If you know which one you get on better with and you aren't paying for prescriptions ask the prescriber to prescribe that particular one.

Ferrous sulphate and ferrous fumerate are cheaper than ferrous gluconate so most people who have iron deficiency are automatically prescribed one of the former two. You can actually buy any of them over the counter at a pharmacy off-prescription but it is up to the pharmacist whether they will sell it to you.

Unfortunately iron deficiency, whether iron deficiency anaemia or non- anaemic iron deficiency, is very common regardless of whether you are pregnant or not so HCPs aren't interested unless it either starts mucking up your other blood cells, or you collapse and end up in A&E.

OP if your breathlessness gets worse over the weekend get someone to take you to A&E don't wait.

Try one iron tablet on alternate days with a soluble vitamin c tablet. My best friend is a haematologist and says recent evidence suggests this rises blood iron as much as three times a day tablets as the vit c helps it absorb and if you take it too regularly the body blocks absorption. Lots less side effects.

You do need to try and get your levels up. They were monitoring mine quite closely last time because I was on the border for being able to go into the MLU. They did manage to get mine right up to 11 at 38 weeks which was loads higher than they’d been all pregnancy so they cleared me for the MLU. That wasn’t to be in the end as had premature rupture of membranes and then I lost a lot of blood and they went down to 9. If they hadn’t managed to get my levels up, I’d have been in transfusion territory post birth. Anemia is one of the risk factors for PPH so it is in your own best interests to get your levels up any way you can.

Mine was 8 and I felt awful
There are so many things you can do with diet though that it doesn’t have to keep dropping
Lots of orange juice, red meat plus and reduce the dose of the pills if they make you initially unwell. Just gradually increase the dose until you tolerate it.
You don’t have to put up with it.

Hi all
Just a quick update that I managed the bank holiday weekend but today (back at work, I’m a nurse) I was so breathless I started to go dizzy and shaky. It was horrible and I have felt awful ever since! Also been getting terrible headaches. Blood pressure is fine so I’m assuming all hb related. I have an appt with the midwife in the morning as I didn’t fancy sitting in triage. Hopefully she takes me seriously!

@Redrosebelle push your midwife for IV iron.

My gp was useless, just kept offering me tablets , which I just couldn't tolerate, gave me such awful diarrhoea I was stuck to the loo and dehydrated.

The midwife took me seriously and really pushed the antenatal clinic at the hospital to agreeeing to IV iron (and I emailed my consultant and he agreed)

My iron level was 96 and my ferritin was 7. Somehow the low ferritin was the clincher...and the fact I'm having a CS. I think iron below 100 and ferritin below 15 and they're meant to offer IV.

I had my infusion yesterday, I don't feel better yet but am hopeful I will soon!

These are my trusts guidelines re anaemia.
They expect you to try 2 weeks of tablets but if you've already done this and it's getting no better and ferritin is also low, then the next stage is IV.

Different trusts use different numbers for iron levels ; below 100 or 10 is usually the trigger for referral - so my 96 was 9.6, if you see what I mean...

Vit C will help you absorb the iron. How much diary are you having? Too much can hinder iron absorption.

Sympathies, sounds horrible. I had low iron in my first pregnancy but not too severe. Think they maybe gave me something called pregaday?