Low iron symptoms

[Darlingbaby]

Hey.
Just after some advice please.
The last week or so I've been feeling horrendous getting worse daily. I'm 31w and just exhausted daily, breathless doing a tiny task and sometimes just sat still and heart beating fast.

My last pregnancy I was admitted for a transfusion at 34w, ferritin low.

I rang the midwife Friday who said my levels were fine. Booking they were 129, 28w at 112. Hb levels. I asked her what the ferritin levels were but was told they don't test for them routinely.

Starting to take spatone as I feel exactly like I did in first pregnancy prior to transfusion. Is there anything else I can do bar diet?

Thinking of paying for private blood test to check feratin etc.

Tia x

I would ask for a ferritin test. It's ridiculous that they don't test routinely, but you're not routine - you needed a transfusion last time and you have similar symptoms again.

If they are difficult, can you ask your GP for a test?

Ring back, directly request a ferritin test given your history. If they don't agree then ask them to put your request and their refusal in your notes. Sometimes that is enough.

You can get a home test, which should at least prompt them to do one themselves.
This testing company is used by the NHS:

This includes ferrtin:
monitormyhealth.org.uk/anaemia-test/

But you really should not have to pay for this.

Once you have a test booked, stop taking any iron supplements such as spa tone a week before to get an accurate result.

Yes, it feels like when you have the flu and can’t move or get out of bed doesn’t it. I had normal HB levels and ferritin which was 10% of the MINIMUM level it should be. I got a fast tracked iron infusion.

Testing only Hb is not an accurate measurement of iron deficiency anaemia. They should know this…

Demand (and I mean demand, my care has been atrocious over two pregnancies and you do have to get forceful to get anything done - even my midwife family member says so!) a ferritin test asap.

My midwifes answer to ferritin on Friday were 'they were OK last may when they were checked last'... 5 years on from my first pregnancy and I didn't get pregnant until October.

She told me to eat more spinach😩

I have an appointment tomorrow so will request more bloods are done. They were trying to say it was a bug I had.

I literally crave ice cubes again... as in eat them. It's horrendous. I'll push tomorrow.

Yes @Supperlite exactly like that, fluey, achey and my limbs feel like led. I cleaned yesterday could only do one room at a time as I was so out of breath in between.

Thank you

With ignorance like that, I'd threaten a complaint if she refuses. Eat spinach? Jesus!

You shouldn't have even have to ask!

I’m having the same issue - anemia in past and really struggling with emergy atm - including being breathless, heart pounding, sleeping every day and just constantly exhausted. Gp refused, A&E (had to attend with breathlessness because of the risk of blood clots in ivf pregnancy). They refused to test ferritin too and only took haemoglobin. said there is no way I’m anemic with those levels. I asked the midwife if ferritin was included in my bloods - she said yes but not convinced! How ridiculous is it?

NHS guidance: www.leedsth.nhs.uk/patients/resources/iron-intake-in-pregnancy-and-beyond/

Key info in screenshots.

They're not.
I was told Friday as standard they don't check ferritin and didn't with me. I'm in Wales though, might be different other parts of the UK?

Thank you.
I'll quote it tomorrow. I'll stop taking spatone in the meantime so they get an accurate result if they retest.

I don't understand how in pregnancy you're iron needs to be 10.5hb to get tablets or treatment but higher in non pregnancy? It doesn't make sense.

Could it be 3w ago I was 11.2 and it's dropped since?

10.5 and 11.2 are your haemoglobin levels? It's normal for haemoglobin to be lower in pregnancy due to the increased overall blood volume. So that would explain the different cut off points.

NICE guidelines say ferritin should be over 30 in everyone (that's still very low, I've been advised to aim for 75-100, not pregnant). Apparently ferritin is a less reliable indicator of iron status after the first trimester, but it's clearly still used to identify women who need supplementation or an infusion.

if you don’t mind pricking your own finger you can buy a ferritin test in Boots that simply tells you if you are below the deficiency threshold of 30. Armed with that you can go to the MW / GP and ask for a proper test.

Welsh guidance, @Darlingbaby:

112 (11.2) at 28w.
But I believe in pregnancy 105 (10.5) or less is required for medication?

Oh interesting! I'll have a look online now.
Thanks

For you maybe. Different trusts and hospitals have different procedures. I asked if she was testing for ferritin and she said yes. So will wait and see for my results.

a few thoughts... it sounds like you're muddling haemoglobin, iron and ferritin a bit - they're not the same thing. Did you have a blood transfusion or an iron infusion in the last pregnancy - again, has slightly different implications. Taking a bit of spatone/stopping it won't make any difference to the test results if they do decide to go ahead, so it's probably better to carry it on if you feel like it's helping. Ferritin would not often be part of the bloods done during an acute presentation in ED - it's relatively expensive and doesn't change the ED management of anything.

A drop in haemoglobin is part of the normal physiology of pregnancy - it's dilutional due to the increased plasma volume and is an evolutionary mechanism that means a bit of blood letting at delivery is better tolerated. That normal drop in haemoglobin may be more pronounced though if someone's iron deficient, and you can of course be iron deficient with a normal haemoglobin. There are other markers that are part of a routine full blood count that will give pointers to whether someone is iron deficient (obstetricians might be a bit more familiar with looking at those bits than the MWs though).

in someone who has symptoms of iron deficiency and a history it would seem fairly sensible to check the ferritin (but bearing in mind that interpreting the results in pregnancy isn't always as straightforward as MN would have everyone believe), but if they don't think that's a problem, then it's worth asking if it could be any of the other causes of breathlessness etc in pregnancy like blood clots/heart problems/PET, particularly if you're symptomatic at rest.

Thank you.
I have an appointment today with midwifery so I'll ask re breathlessness and general symptoms of id.

Last time the one that gave it away was pica, eating and craving ice cubes. It wasn't until I mentioned this in the midwifery appt around 34w she checked my results of 28w and realised I was anaemic. By then I was too late to begin ferrous fumerate (but historically I get horrendous stomach pains with them) and was put on iron IV.

It's the symptoms this time that makes me question the results, or whether it's as simple as my hb level has dropped in 3w.

Who knows eh?