When is an iron infusion warranted? Is there a "magic number" (or red flag, I...

Hi, everyone -

I have iron deficiency anemia and PCP sent me to a GI doctor. I guess this is sort of SOP. So I had a colonoscopy and EGD (wee!!!) to seek out source of suspected bleeding - both looked fine. Next they want me to do a pill cam to see my small intestine. As cool and sci-fi as the pill cam sounds, it really seems like overkill to me.

But in the meantime, my PCP (at recommendation of GI too) is sending me to a hematologist. She said an iron infusion might be helpful. But I don't know if I am really anemic enough to justify that... my numbers have improved a little bit in the last couple of months as I've been taking extra iron. I'd love to hear from my fellow bariatric patients on this.

Latest iron deficiency bookwork is this:

RDW-CW 17% HIGH MCH 23 LOW Hemocrit 35% LOW Hemoglobin 11 LOW Iron 32 mcg/dl LOW Transferrin 284 mg/dL HIGH Calculated TIBC 538 mcg/dL HIGH % Saturation 6% LOW Ferritin 12 ng/mL LOW

Sorry to not have ranges here, but most of them (exception of RDW and % saturation) are very close to borderline.

The hematologist might just recommend a different type of iron, or more of it. But I wondered if I should be requesting an iron infusion to give me a jump start to getting my numbers back to normal ... or if these are really not off enough to warrant pushing for that? Is there any sort of cut off number hematologists use to determine if an infusion would be helpful?

Love to hear from anyone with experience with iron infusions or anemia. I do have a lot of fatigue, so I really want to get my iron numbers looking better.

Also... they are doing all this searching for internal bleeding - which I get is protocol - but isn't this likely just caused by my sleeve? All this testing seems really unnecessary! Any other sleevers here struggling with anemia?

With those numbers, take the infusions. Could be you could take a bunch of extra iron and bring the ferritin up, but iron is really low to respond.

If you've been taking iron conscientiously and it still has dropped, take the infusions.

One sure sign of internal bleeding is passing blood, and/or strange bad gas smells. The strange smell would be your body trying to digest raw blood.

But most likely it's from WLS. The rules are different for us, and hopefully your hematologist will understand that.

^^ What he said.

I had an infusion with a ferritin of 5, I believe. My iron was great until a large amount of blood loss during an extended hernia (actually 3) repair. I just couldn't get my stores back to normal.

As your Dr/hematologist about getting injectafer infusions http://www.injectafer.com/ (quick 2 bags, a week apart, 30 minutes each), less reactions, and it got my numbers up again quickly... I was ferritin 2 and I take it faithfully and eat super iron rich foods... just the double edge of a malabsorptive procedure.

take the infusions, I did a total of 5 Iron infusions in 2 weeks 30 min each time,

my ferritin was 4, I tried to increase it eating right taking oral iron of all sorts but my numbers just keep decreasing

is been 2 months only but I feel the difference a complete change,

good luck!

Update...

Doing the pill cam tomorrow (so just took the "clean out" magnesium citrate and fasting in preparation - good times! LOL!)

I went to see a hematologist. He took my bloodwork in his office and my CBC had dropped more... Hemoglobin was 10 (or just below) and Hemocrit was 33... other numbers were also worse. This explains why I just keep feeling more and more run down. I don't have new iron numbers, but I'd imagine they are lower than previously reported.

The doctor was almost certain the anemia is due to the gastric sleeve, and removing a big part of my stomach means I'm not absorbing the iron I'm taking. So he wants to do iron infusions and thinks I'll feel better once I get my levels up. He said I'll probably have to do them for life, but might only need to do them yearly or so - it will depend on how I do when them I guess. He's doing some other bloodwork to rule out other cases of anemia but is pretty sure my sleeve is the cause.

So hopefully the pill cam tomorrow will show nothing worrisome and I can feel certain that this anemia is just caused by the sleeve. Here is what makes me scratch my head, though... I have no idea why it would suddenly show up like this... I mean, my sleeve was over 5 years ago. Why the delay in anemia when I've been taking iron all along? Maybe this is a common pattern for sleeve patients, I haven't found much online about it - most resources online talk about gastric bypass and anemia, not so much sleeve and anemia.

Anyone here familiar with Feraheme iron infusions? I saw that was the brand he put on my chart. How quickly do you feel better after infusions?

I'm very optimistic that the iron infusions will really help with my fatigue. If I can start feeling human again, I can start exercising again - which will help with feeling better in general, for sure.