Dr. Hive: Fatigue with normal hemoglobin but low ferritin ??

[Tiramisu]

I'm revisiting this topic because dd is still unusually tired with no explanation. Would someone with normal hemoglobin but low ferritin have fatigue?

[jessicamcc]

Absolutely! I have normal hemoglobin and extremely low ferritin. It's been a problem for a few years now. Can I ask what her ferritin level is?

[dancer67]

Hemoglobin is just a part of the big picture when it comes to IDA. I was DX with Iron Def. Anemia almost 3 years ago. To this day, I take 3 iron pills a day. A full iron panel needs to be done. This includes: CBC/differentials. In this, the most important things are: Hemoglobin, RBC, Hematocrit, RDW-CV, MCV, MCH. Then, you need to have a Serum Iron test, TIBC(Total Iron Binding Capacity), Saturation Rate, and Ferritin. Low ferritin is defined differently by different hematologists. My Heme Dr. likes to see at LEAST 65 and above, but that has never happened. My ferritin started at an 8. The lab levels are (well here anyways) is 20-160. Mine has been falling around 30-40. If you have your period, every woman should be taking iron. Preferably in a multi vitamin. And those finger picks at the GYN are unreliable. I would ask for that full Iron panel to be done to see if there is IDA. And again, it would be helpful to know what that ferritin number is. Right now, I get bloodwork drawn every 6 months, and will continue until I go through menopause(I am 45 now). IDA should not be taken lightly, and I think to many Dr's are ignoring it, and then you end up with IV Iron(which did not agree with me, I passed out), or a blood transfusion. All this eating iron rich foods will not reverse IDA if you still bleed. It is always 1 step forward and two steps back. And if you are NOT bleeding, and have low ferritin, then the cause of the bleed should be found.

[dancer67]

I also want to add, depending how low the ferritin is, that HGB will not stay normal for long.

[sbgrace]

There was a study on fatigue in non-anemic but ferritin deficient women. Here is the medical journal article about the study. The conclusion:

 

 

Interpretation: Iron supplementation should

be considered for women with unexplained

fatigue who have ferritin levels below 50 µg/L.

 

So yes it can.

 

Did they run a vitamin D (25 OH D) test too?

[Tiramisu]

I also want to add, depending how low the ferritin is, that HGB will not stay normal for long.

 

That's what I'm thinking.

 

CBC was done and all numbers are normal. Hemoglobin in 13. Ferritin is 18.

[Tiramisu]

There was a study on fatigue in non-anemic but ferritin deficient women. Here is the medical journal article about the study. The conclusion:

 

 

 

 

So yes it can.

 

Did they run a vitamin D (25 OH D) test too?

 

Thanks for the link.

 

Vitamin D was 27 and we're supplementing. Pediatrician didn't think we need to be supplementing iron, but I've started giving her some anyway, just stuff I had in the cabinet, and adding vitamin C. She won't take a multi because she has a hard time swallowing bigger pills. I give her gummies but they don't have iron.

 

While I'm at it, the other weird stuff that came back in her blood work. Eos was elevated at 9. I don't think that's all that high. Cholesterol was 100 (really low) and triglycerides were 105 (high), which I read can happen after an illness.

[Tiramisu]

Absolutely! I have normal hemoglobin and extremely low ferritin. It's been a problem for a few years now. Can I ask what her ferritin level is?

 

jessicamcc, we have scary things in common--blood and guts!

 

(The mag did the job by the way!!!)

 

So, have you done anything special to raise your ferritin levels?

 

Should I tell you my older dd with fatigue has low ferritin, too? I have to check her number. I don't think it's quite as bad, though. I have been giving her iron because she's always been borderline anemic with a high RDW that went down when her hemoglobin went up. That's why I had it on hand.

[Harriet Vane]

Yes, low ferritin IS anemia, though many doctors are not up on the research. You will have ALL the symptoms of anemia if your ferritin is low. I had low ferritin for many years. My first doctor tested only hemoglobin and kept telling me I was fine. My second dr did a more thorough panel (as Dancer describes in a former post) and found low D and low ferritin. Aggressive supplementation with iron plus an iron-rich diet changed. my. life.

 

If your dr has not prescribed iron pills, then get a different dr who is more knowledgeable on this problem and the current research. If your numbers are really low, you would want to start off supplementing at about 150mg per day plus vit C. Re-test in six months. Continue testing every six months until your numbers are better. Eventually you should be able to back down the iron dosage to more like 50mg per day as a maintenance dose. Once you are maintaining better iron levels over at least two testing cycles, you can then test just once a year.

 

It takes a loooooooooong time to build up your iron stores. Diet alone will not do it. My numbers did not hit the bottom of the "normal" range until I had been supplementing for eight months. It took years to continue building past the low end of normal. I now take a maintenance dose of 50mg a day, plus vit D.

[jessicamcc]

jessicamcc, we have scary things in common--blood and guts!

 

(The mag did the job by the way!!!)

 

So, have you done anything special to raise your ferritin levels?

 

Should I tell you my older dd with fatigue has low ferritin, too? I have to check her number. I don't think it's quite as bad, though. I have been giving her iron because she's always been borderline anemic with a high RDW that went down when her hemoglobin went up. That's why I had it on hand.

 

WAAAY too much in common! I'm glad the mag is working; L is doing a lot better with it, too.

 

My ferritin level was 3 in the beginning. I really scared my doctor! I kept taking iron, but it wasn't helping, I only went up to 7. My one doctor put me on 650mgs with 1000 of vit. c every night. That finally did the trick. (I had changed my diet to try to help in the beginning, but there was no way I could eat enough.) It did take awhile to build up to somewhat normal range, but I felt so much better! Fast forward a year and I was feeling awful again (this past November) and got rechecked- my iron was back down to 5. Ugh! I had been slacking off on taking the iron; since I had gotten better, the doctor was afraid of me having too much.Now the doctor has me on 975mgs with 1000vit C every night. Sigh, but I am starting to feel better. He said it was crucial to have the vic. C with the iron for absorption.

It is very important to find the cause, you need to know why her level is so low. (Ihave extremely bad periods and a did have a bleeding ulcer.) Have they checked her thyroid levels and her Vit. D levels?

My Vit. D was very low- 11. Low iron and low vit.d can be caused by thyroid problems, which I found out I have.

Sorry for the TMI, but I hope I helped. Keep us updated; your poor baby has suffered enough.

[sbgrace]

My son struggled with low ferritin (never low hemoglobin). What finally helped him was ferrous bis-glycinate/ferrochel. It's absorbed better and doesn't have GI effects like other iron supplements.

 

Her D is low. You want her to be at 50. Most people will maintain current levels with 1000 IU of D3 per 25 pounds. So they need more than that, significantly more, to raise a low level. If you're using D3 I would dose her high. That low in vitamin D will affect energy.

[ZeeMommy]

As far as iron and absorbtion goes, there are 2 kinds of iron: heme iron, which is found in foods like liver and red meat (think stuff with hemoglobin in it), and

non-heme iron, found in foods like beans, spinach, rasins, etc. Non-heme iron is also a kind that's in your typical iron supplement. Heme iron is best absorbed by the body; non-heme iron needs vitamin C to be absorbed. Here's some links on the subject: http://www.webmd.com/a-to-z-guides/ferritin?page=2, http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/, http://labtestsonline.org/understanding/analytes/ferritin/tab/glance (try this one first, has a good chart showing what different levels indicate which illness). Hope this helps.

 

(P.S. the http://labtestsonline.org website is a favorite of mine, since you can search by tests, conditions/diseases, or screening; it's put together by a professional lab organization.)

[Tokyomarie]

I have battled fatigue at some level for years. Have been post menopausal for a few years now. Only rarely have I tested with a low Hb, and the last time that happened it was connected to a particular medication. Once that med was eliminated, my Hb came back up. Last summer, my doctor decided to test my ferritin and Vit. D. Interestingly enough, my Hb was the highest it has ever been (13+), but my ferritin level was on the low side. Not extremely low, but a fair bit below 50. My Vit. D was extremely low.

 

I am regularly tested with a CBC because of medications I take, but I have never had a TIBC, serum iron, or saturation rate.

 

My doctor prescribed Ferrogels Forte; it has B12, folic acid, and Vit. C in addition to 150 mg of iron. I am supposed to take one daily, but I have been unable to tolerate taking it daily because it causes constipation- even though I take additional Vit. C plus magnesium. Any thoughts on what else I can do to prevent the constipation?

[Crimson Wife]

I had to take Slow FE during one of my pregnancies because I was anemic but couldn't tolerate regular pre-natal vitamins.

[lailasmum]

Timely post. I had tests show normal hemoglobin and low ferritin (it was 4). I felt dreadful, tired, swollen joints, low blood pressure and fast heart beat and feeling faint. That was two years ago. I took supplements at a high level and they did help after a year or so of taking them.

 

I think I am back to having low iron again though as I feel dreadful again and fainted last night and hit my head on a concrete floor. I look like I've been beaten up. It's annoyingly hard to keep on top of as I never completely stopped taking iron, just went to a lower dose.

[dancer67]

A ferritin level of 18 is not critically low. But it is low. She does need iron supplements. Her HGB is going to drop everytime she gets her period because she is going to deplete those iron stores. I take Vitron-C. It has Vitamin C in it.Plus I take an extra 500mg of Vitamin C with it. It has not caused me any stomach problems. I take two TBSP of Blackstrap Molasses at night. for the Iron, and for the "bathroom" issue)(never constipated) She really does need a full iron panel done to see where all of her numbers lie. A hematologist is the best Dr. to see about this. He/she can also address the Cholesterol issue. It sounds like she may have something underlying going on. But they are the best ones to interpret that. And I would not start ANY IRON supplements until you speak to your Dr. You need to know how much and for how long. Iron can be dangerous if you are taking it without a Dr. telling you how much. Never self treat with iron. He/she may suggest IV iron to give her a good head start. But make sure you ask for pre-meds before having any IV infusion. This will help in case the IV iron does not agree with her, as it did not with me. If she is a heavy bleeder, you may want to speak with her GYN to get her on BC pills. I don't know how old your daughter is, but sometimes they even want a colonoscopy/endoscopy to rule out any bleeding coming from there. I had to have both, because then they know for sure what is causing your iron stores to deplete. I am to old for BC Pills,and tried the Mirena and hated it. So now, I just deal with it until menopause. But if I was younger and did not have high blood pressure, I would take the Pill. Both my girls are on it and they have 2 very light day periods and their iron stores are great. I hope she feels better. PM me if you have any questions.

[dancer67]

Timely post. I had tests show normal hemoglobin and low ferritin (it was 4). I felt dreadful, tired, swollen joints, low blood pressure and fast heart beat and feeling faint. That was two years ago. I took supplements at a high level and they did help after a year or so of taking them.

 

I think I am back to having low iron again though as I feel dreadful again and fainted last night and hit my head on a concrete floor. I look like I've been beaten up. It's annoyingly hard to keep on top of as I never completely stopped taking iron, just went to a lower dose.

If you are still bleeding, you need to stay on the same dose for the rest of your life until your periods have ended. You need to have a blood draw for iron at least every 3-6 months. Dr's have to adjust your iron intake. You cannot do this yourself. My SIL mom had a ferritin of 4 and had a blood transfusion. At the very least, you should have had IV Iron to get those stores up. Hope you feel better.

[lailasmum]

If you are still bleeding, you need to stay on the same dose for the rest of your life until your periods have ended. You need to have a blood draw for iron at least every 3-6 months. Dr's have to adjust your iron intake. You cannot do this yourself. My SIL mom had a ferritin of 4 and had a blood transfusion. At the very least, you should have had IV Iron to get those stores up. Hope you feel better.

 

 

I'm going to go back and get some more blood tests done I think. When I initially went in my Doctor wasn't very helpful really with advice on what to do, how long it was going to take to feel better etc. I wasn't actually told to go back at all beyond my test result appointment & prescription so all my information has been gleaned from the internet and a helpful pharmacist.

[Runningmom80]

This is so timely. I was diagnosed with anemia last week. My hemoglobin was 8, ferritin was 14. I have low vitamin d, but my b12 was normal. I do take b12 supplements because I eat a plant based diet.

 

Anyways, I've been researching, and it seems that ferritin is a better indicator than hemoglobin.

[dancer67]

This is so timely. I was diagnosed with anemia last week. My hemoglobin was 8, ferritin was 14. I have low vitamin d, but my b12 was normal. I do take b12 supplements because I eat a plant based diet.

 

Anyways, I've been researching, and it seems that ferritin is a better indicator than hemoglobin.

That is good that you can absorb B12. But, I am sure you already know that B12 and Iron are completely different. Your HGB was really low. I started with a ferritin of 8, and my HGB was 11.1. I think anyone who has IDA should be followed by a Heme Dr. Your regular Dr. isn't as informed on this. My Dr. only wanted me to take one iron pill a day. It is a good thing she still referred me to a Heme. And yes, Ferritin is the key number for anemia. I sure hope you are feeling okay.

[Runningmom80]

That is good that you can absorb B12. But, I am sure you already know that B12 and Iron are completely different. Your HGB was really low. I started with a ferritin of 8, and my HGB was 11.1. I think anyone who has IDA should be followed by a Heme Dr. Your regular Dr. isn't as informed on this. My Dr. only wanted me to take one iron pill a day. It is a good thing she still referred me to a Heme. And yes, Ferritin is the key number for anemia. I sure hope you are feeling okay.

 

 

Thank you, now I am definitely going to ask about seeing a heme. My dr put me on 3 supplements a day, and ill get checked again in 2 weeks.

 

 

I've been anemic on and off since I started menstruating. I know my vegan diet isn't helping the situation, but I'm confident it didn't cause it.

 

Ill definitely ask for a referral, thank you for mentioning it, I wasn't sure I needed to see a heme since my dr didn't mention.

[Tiramisu]

A ferritin level of 18 is not critically low. But it is low. She does need iron supplements. Her HGB is going to drop everytime she gets her period because she is going to deplete those iron stores. I take Vitron-C. It has Vitamin C in it.Plus I take an extra 500mg of Vitamin C with it. It has not caused me any stomach problems. I take two TBSP of Blackstrap Molasses at night. for the Iron, and for the "bathroom" issue)(never constipated) She really does need a full iron panel done to see where all of her numbers lie. A hematologist is the best Dr. to see about this. He/she can also address the Cholesterol issue. It sounds like she may have something underlying going on. But they are the best ones to interpret that. And I would not start ANY IRON supplements until you speak to your Dr. You need to know how much and for how long. Iron can be dangerous if you are taking it without a Dr. telling you how much. Never self treat with iron. He/she may suggest IV iron to give her a good head start. But make sure you ask for pre-meds before having any IV infusion. This will help in case the IV iron does not agree with her, as it did not with me. If she is a heavy bleeder, you may want to speak with her GYN to get her on BC pills. I don't know how old your daughter is, but sometimes they even want a colonoscopy/endoscopy to rule out any bleeding coming from there. I had to have both, because then they know for sure what is causing your iron stores to deplete. I am to old for BC Pills,and tried the Mirena and hated it. So now, I just deal with it until menopause. But if I was younger and did not have high blood pressure, I would take the Pill. Both my girls are on it and they have 2 very light day periods and their iron stores are great. I hope she feels better. PM me if you have any questions.

 

Thank you for all the information. A specialist we've seen has agreed to look at all of her numbers and guide us. She has a lot of medical anxiety because of a major surgery at a young age and then had a bad reaction to the recent blood draw, so I want to get all the information I can before deciding where to go.

[Runningmom80]

Dancer, can I ask you another question since you seem so knowledgeable? I've given up coffee because I read that coffee and tea can inhibit iron absorption. Is this necessary, in your opinion?

[In the Rain]

Dancer, can I ask you another question since you seem so knowledgeable? I've given up coffee because I read that coffee and tea can inhibit iron absorption. Is this necessary, in your opinion?

 

 

My hematologist did not suggest dietary measures. Perhaps if your numbers are very low, medical treatment is seen as the best route to health. I was given iron infusions, and they helped tremendously.

[dancer67]

Dancer, can I ask you another question since you seem so knowledgeable? I've given up coffee because I read that coffee and tea can inhibit iron absorption. Is this necessary, in your opinion?

You don't have to give it up. But if you drink it, wait at least an hour after you take your iron before you consume any dairy, tea or coffee. Take a Vitamin C pill(500mg) with your iron and drink orange juice. You don't have to drink a full cup. You can just drink a small, bathroom size cup of OJ. When you eat lunch or dinner, try not to drink milk, tea or coffee with it since the iron from your foods will not absorb as well. Try to drink orange juice if you can. If not, the vitamin C pill you took in the morning should still help with absorption. I could never give up coffee. My routine is to take my two iron pills, Vitamin C pill with OJ. Then take a shower, do some cleaning. And by that time it has been an hour and I can have my coffee, or tea. And I take my one iron pill at night with OJ before bed, so I don't need to worry about dairy or coffee. So don't give it up!!! :grouphug:

[dancer67]

 

My hematologist did not suggest dietary measures. Perhaps if your numbers are very low, medical treatment is seen as the best route to health. I was given iron infusions, and they helped tremendously.

Yes. If ferritin numbers are very low they will suggest IV Iron. Sometimes a blood transfusion. I always tell people if they need to get IV Iron, that they should be pre-medicated first(With Benadryl, and anti-nausea), and if you are taking medication for high blood pressure make sure they check it prior to the infusion. Even if you do not have high BP. If your BP is already low, IV Iron can cause hypotension(as it did with me) and made me pass out. Or, if you are not pre-medicated, IV Iron can make you very, very sick. (as it did with me the first time). Make sure they do a test dose. And do not leave that Chemo room for at least 2 hours after the infusion. Make sure they give you a very small dose, dripped very slowly. Then if no reaction that day, they can bump it. IV iron can really boost your ferritin quite quickly. But it also depletes very quickly if not placed on oral iron right away. If you are bleeding from your periods, your ferritin will quickly drop again if not given the correct oral iron dosage.

[melmichigan]

My son struggled with low ferritin (never low hemoglobin). What finally helped him was ferrous bis-glycinate/ferrochel. It's absorbed better and doesn't have GI effects like other iron supplements.

 

Just a quick thank you regarding the Ferrochel, I switched after you posted about it, my Doc was comfortable with 50 mg a day because I didn't want a transfusion or IV iron. Almost a year later my hgb is finally crept just into normal. I still have zero iron stores, and saturation is low, but it is progress. The fatigue is finally getting better and I've been cleared for exercise again. I will never go back to any other form of iron again. Eventually we are hoping for 25mg as a maintenance dose once all my levels are normal, but that might be another year yet and will have to be monitored closely.

[sbgrace]

Just a quick thank you regarding the Ferrochel, I switched after you posted about it, my Doc was comfortable with 50 mg a day because I didn't want a transfusion or IV iron. Almost a year later my hgb is finally crept just into normal. I still have zero iron stores, and saturation is low, but it is progress. The fatigue is finally getting better and I've been cleared for exercise again. I will never go back to any other form of iron again. Eventually we are hoping for 25mg as a maintenance dose once all my levels are normal, but that might be another year yet and will have to be monitored closely.

 

 

I'm glad it's helped. We tried at least three different iron supplements with him and got no response. This went on for two years (low ferritin, not low hemoglobin so no one was freaking out except me). Finally we tried the bis-glycinate and he had normal ferritin on the next test. He's been taking it, at maintenance doses, ever since. I won't use anything else here.

[Runningmom80]

 

You don't have to give it up. But if you drink it, wait at least an hour after you take your iron before you consume any dairy, tea or coffee. Take a Vitamin C pill(500mg) with your iron and drink orange juice. You don't have to drink a full cup. You can just drink a small, bathroom size cup of OJ. When you eat lunch or dinner, try not to drink milk, tea or coffee with it since the iron from your foods will not absorb as well. Try to drink orange juice if you can. If not, the vitamin C pill you took in the morning should still help with absorption. I could never give up coffee. My routine is to take my two iron pills, Vitamin C pill with OJ. Then take a shower, do some cleaning. And by that time it has been an hour and I can have my coffee, or tea. And I take my one iron pill at night with OJ before bed, so I don't need to worry about dairy or coffee. So don't give it up!!! :grouphug:

 

Thank you so much! I haven't actually seen my dr since I got my results, only talked over the phone, so I have just been googling to figure everything out.

 

I usually have just a cup in the AM, but I had given it up last week. I'm excited to hear I can add it back!

 

Thank you again! I really appreciate the help!

 

Sorry for the thread hijack OP!

[Tiramisu]

Thank you so much! I haven't actually seen my dr since I got my results, only talked over the phone, so I have just been googling to figure everything out.

 

I usually have just a cup in the AM, but I had given it up last week. I'm excited to hear I can add it back!

 

Thank you again! I really appreciate the help!

 

Sorry for the thread hijack OP!

 

I really appreciate this conversation! I'm learning a lot! :001_smile:

 

I contacted an "expert" who said with dd's numbers, she may not have IDA but she is ID. I'm still waiting to hear from the specialist who was away.

[dancer67]

Glad I could help. And to the OP, I hope you get a correct DX. If she is just ID, usually a good quality multi-vitamin with iron(18%) should help her.