surery cancelled and getting iron infusions

Dr. LoMonaco,

What do you consider the minimal lab numbers for Hemoglobin and Hematocrit to move forward and have surgery safely?

I hope to have PS at the end of the month but I think my Hematocrit it too low. I believe its 33. (from my last lab result in August)
I just took my pre op blood work but haven't received the results yet.
My pre op appt is next Thursday.
Thanks for any information you can provide. (Don't worry, I understand every Dr. has their own opinion, just looking for yours)

Thanks again!
Judy

Hi Judy up there in Bear !

Well, every lab has its own reference range but I like to see a hemoglobin of 12.  Now the kicker is that you can have  a normal or near-normal hemoglobin and hematocrit level, but still be severly iron depleted.

I have seen this many times, and it fools a lot of doctors when they see a normal blood count they assume the iron level must be OK.  Doesn't work that way.

It takes the extra lab tests I mentioned above to really determine your iron status.  You need those reserves to build up new blood cells after surgery and for many other functions as well:

http://www.chemistry.wustl.edu/~courses/genchem/Tutorials/Fe rritin/IronBody.htm

Remember, you will be undergoing a big surgery which will simultaneously cause bleeding (iron loss) AND increase iron demand because you also need the tissue healing.  Iron does way more than just blood cells.

Iron deficiencies ar eusually months in the making, and cannot be corrected by oral supplements overnight.  It can take weeks.  That's why you have to get to work on this early.

Thanks for responding!

I almost feel if I'm the only one worried about my iron level.  I reviewed my test results with my PCP in August and he just replies, oh we'll just monitor it.  So I made an appointment with my bypass doctor.  He just said, yes, it's a little low but thought I would be able to have surgery anyway.
I made him give me a referral to a hematologist.  Appointment is in 10 days.

What no one seems to understand is my Ferritin has dropped from an already low 6 in December to an even lower 5 in August.  I realize that my storage is slowly depleting even though my iron in my level is 56, normal range.

I am prepared to delay PS until my iron level all around are good.  I pretty sure an iron transfusion is going to be the answer!

Thanks again!
Judy

HI Judy.  You are thinking the right way on this.  MOST of the iron stored in your body is stored as ferritin, so a low level like yours shows that you are depleted.

I will generally try my patients on an oral supplement (often adding Vitamin C to aid absorption)  for 3-6 weeks then check levels.  In patients who have not been good about taking their supplements in the past, I will often see a nice response.

Others just can't  get or maintain a good level on oral supplements alone and an iron infusion is needed,  iron infusions are not benign therapies and must be monitored  for allergic reaction,  so it's a last resort treatment but sometimes is needed.