Low ferritin

Seems like the patches aren't working for you since you're trending downward and it probably won't get better without infusions.

Unfortunately many of us who have had malabsorptive procedures (RNY, DS) find ourselves in this situation. I've been anemic for almost 13 years (I'm 15 years post-op). My numbers are bad whether I take oral iron or not. I no longer waste my money on oral iron and get infusions about once a year. My hematologist feels that any ferritin under 50 is anemic. I have learned the signs and symptoms of iron deficiency anemia and try not to let myself get that far low.

Find a hematologist who understands malabsorption.