Anemia....need input

I knew that my iron had started trending down at one year out and increased iron supplement (although my surgeon did not say I needed to do this).    At my 2 year surgeon appt in March, he said it was trending down but did not say how much.  I always ask for a copy of my labs but forgot to that day but became diligent in taking 50 carbonyl iron each night.  About 6 weeks after my appt, a physician I work with noticed my swollen lymph node on my neck, and suggested that I get it checked out (it has been there off and on for 20 years).   I decided to make an appt with my primary care physician as I have been very tired and wondered if I was experiencing hypothyroidism.  I called my surgeon to get a copy of labs and saw that my total iron was at 41.  Saw my PC physician and she ordered a full iron panel.

Some #'s are:

hemoglobin 10.1

hematocrit 32.1

iron sat % 5  (normal is 15-55)

total iron count 24 (normal 40-150)

ferritin 4  (normal 11-264)

My primary care physician is concerned and told me to double up on my iron (now taking apprx 150 a day, mostly carbonyl and also heme).  She wants to get new labs in a few weeks and I also went on the birth control patch to see if that will help.  I do not have high hopes that my iron is going to improve.  I was never anemic before.  She wants to see me in a few weeks to discuss what to do next and see if my labs improve.

Some questions:  should I ask for prescription iron or is is time to think about infusion?  Is this something a hematologist has to arrange?  Has anyone increased their iron by supplement only?  My primary care physician is lovely but not experienced with weight loss surgery but has always been open to suggestions and info (like me starting on the patch).  I am VERY fatigued and am struggling with much less exercise which is also causing some small re-gain.  My TSH was normal although I still wonder about that as well.

Any thoughts...

~~Jennifer

You may wish to ask for a referral to a hematologist.  They are the experts.

Anne

Oh man!  As low as your levels are I'm surprised you weren't sent to a hematologist for iron infusions. For most of us malabsorbers (RNY and DS) when your numbers are that low supplements won't help much at all. You really need to push hard for a hematologist that understands WLS. The sooner the better. Please keep us posted.

--gina

Okay, that input is helpful.  From what I have read, it seemed like supplementation wasnt going to work.  My numbers dropped FAST!  The best part is my surgeon didnt even MENTION that I may be anemic.  My internist was very concerned when the labs came back.  She was hoping that since I had just had my period, that this may be why my hematocrit/hemoglobin was low.  She has little experience with weight loss surgery so I appreciate her concern but I may need to push for what to do next.  Which is why I am coming to you all....the experts.  The tiredness is getting to me and I have a really busy job.

Blessings....

Jennifer

For me, looking at your numbers, the big issue is your ferritin. A level of 4 means you have no iron stores. That's bad.

My experience is that once you get your ferritin up, supplements of the right kind could keep them up, but that getting ferritin up on supplements alone is a long haul. And some people can't keep them up with supplements either but that seems rarer.

I don't know what the prescription iron is made of by carbonyl and heme iron absorb the best. And you can get them OTC.

First, I'm sorry you are having to deal with all of this. It must be very frustrating.

For what it's worth, I became anemic and was able to get back in the normal zone through supplements alone. I take one 325mg tab in the morning and at night. I also take Vit C per doctor instructions to improve absorption.

Good luck

Sorry to hear you are going through this. I had similar issue last year. I needed to have an ablation for the heavy periods I was experiencing. Was anemic with low iron stores. Anemia is resolved and iron stores are slowly trending upward.

I was placed on ferrous forte, prescription. Taking it twice daily. Making sure that I do not take it close to calcium, dairy, coffee or tea.

Hope you get things straightened out soon.

Thanks guys....I think I will get my labs done early (next week) and then call my physician and ask for results and referral to a hematologist here in town.  I am going to ask some cancer folks who they would recommend (I work in palliative care).  I don't think I can take this exhaustion long term and my weight cannot handle not being able to exercise.  I need to be burning some serious calories right now with malabsorption of calories gone. 

One last question....how much carbonyl iron do you think one can take at a time?  I have tried to research this to no avail.  Some of you are taking higher doses so maybe I can try this as well. 

450 mg is on Vitalady's deficiency schedule.  I don't know how someone with RNY would do that due to the constipation issues iron would cause though.

I took 300 mg of carbonyl in the afternoons and 2 Proferrin tablets snapped in 2 at bedtime to bring my levels up but I was not in the deficient range, so supplementation worked great for me.

--gina

The ferrous fortes are 460 mg with b vites. Take 2 a day