Carbonyl vs heme iron

Since your b12 levels were high, I am assuming over 1000, did you cut your dosage? If so, then that is your problem.  We want our B12 levels to be atleast 1200-1800 but unfortunately many doctors dont understand our malabsorbtion and when they B12 come back high, they immediately tell patients to cut there doses way down and then wonder the next time why they are anemic.  The B12 will probably will probably still be in range but in range for a regular person not a malabsorbing WLS patient.  The normal range is 200-900 or 200-1100 depending on the labs but for us, anything less than 500 puts us at risk for nerve damage and if left that way long enough it can become permanent.  If your levels are down in that area it would definitely explain the the low RBC, hemoglobin and hemacrit.  Your iron and ferritin are too high to be causing it.  The only other things it could be are the folate which we want greater than 24 or it could be vitamin B6 but this is very rare since we tend to run too high.

So, please get your vitamin B12 level checked, ask him to do a folate and B1 and B6 while doing it. B1 can cause nerve problems too - not sure if it can cause anemia though.

In the meantime, I would double your B12 dosage - it can't hurt you but being too low can.

My B12 had been >1999, apparently they only go so high in normal testing, but no I did not drop the dosage and my PCP had not indicated he was concerned aout the "above normal" reading. I was prepared to discuss if he did. We drew blood yesterday for B12 and folate. Hopefully, I will see those results on Monday.

I have been struggling with anemia as well. I started with Heme Iron but my ferritin levels only went up by 2 points. I have increased my dose of elemental iron to 240-360  mg of carbonyl iron per day with 400 mg vit c per capusule..its the tender iron sold by vitalady. I also take a b complex with it. I have read that the Bs may help with absorption as well. 

I can tell from my own labs that it takes a while for iron to bump up. However, even with the ferritin up by a few point I feel a lot better..I can tell that my body feels warmer.

I also tried eating more iron enriched food like farina, or liverwurst. Both suck. I dont think they really had an impact.

I think the carbonyl iron can still cause constipation. I still take some miralax whenever I need it.

Avoid caffeine, calcium, fiber, when taking your iron. It doesnt help with the absorption.
 
Michelle

Well, just got the labs from my PCP and the B12 and folate were off the chart high, as they have been. However, he had run one other test and here are his comments:
Your reticulocyte count is elevated which means you might be bleeding somewhere, leading to the slight anemia. Your body is responding by increasing production of red blood cells, which is reflected by an elevated reticulocyte count. We should have you come in to have this looked into.

Any thoughts?

I just looked up an increased Retic count and it could mean a couple of things  - active bleeding but with your iron numbers and hemoglobin, I doubt it.  The main reason that I tend to believe it active treatment for iron or B12 deficiency.  You are currently taking iron and B12, so this would increase your retic count.

If you have any concerns, see a hematologist, a PCP shouldn't be dealing with these blood issues.