Dr. Hive, please help dd ferritin less than 1 (anemia)

[Tiffnkids]

My daughter (almost 16) recently had bloodwork that revealed a ferritin level of less than 1. Hemoglobin was okay at 13.2, hematocrit 38.5.

 

The physician's assistant that we saw recommended iron supplements (325 mg ferrous sulfate, 3x daily) and blood work in 4 weeks with a possible referral to a hemeatologist if no significant improvement.

 

Does that seem right? I have read about the need from blood transfusions or iron transfusions when ferritin is very low.

 

My daughter is always exhausted, weak, pale, and generally feels awful. I want her to feel better.

 

Her cycles are light, she eats a decent diet (not a ton of meat, but some, lots of beans, green veggies, etc.), takes a daily multi vitamin with iron.

 

I don't want her to drag around feeling like garbage for another month, then 2 more weeks until we get results from blood work, and then who knows how long until a referral with a heme doc.

 

Any advice appreciated.

 

UPDATE: We have been referred to a hematologist. Hopefully, we can figure out what is going on.

[Seasider]

I would want to be diligent to determine the cause of this low level. Did the PA mention further diagnostic testing (ie, additional blood work or an endoscopic procedure)?

[Tiffnkids]

No mention of any additional testing, just iron supplements and retesting in a month.

 

I definitely do want to know what is causing her ferritin to be so low. She doesn't have any digestive issues (no nausea, has normal regular BMs, etc.). No known allergies except for maybe mild seasonal allergies.

[FaithManor]

I would want to be diligent to determine the cause of this low level. Did the PA mention further diagnostic testing (ie, additional blood work or an endoscopic procedure)?

This! And in the mean time, she should increase beef even if she doesn't want to, a little liver wouldn't hurt for certain, plus beans, plus broccoli, plus oats, plus spinach...each meal should be loaded with opportunities to absorb iron.

 

But, she needs to be a friend to her digestive track. She should be tested for unknown food allergies which may be causing her to be unable to absorb iron or nutrients that aid in this, and some of this should include blood work for celiac/wheat gluten sensitivity. She should take extra vitamin C, B complex, and chromium polynicotinate all of which aid the digestive process. Some acidophilus wouldn't hurt just in case her good bacteria is running low which also increases the likelihood of digestive problems.

 

If necessary, my sister did this on her doctor's recommendation when she was running way too low, she could also consume 1-2 oz. of a good red wine prior to each meal. There are many good digestive enzymes in wine that can help break down her food.

 

Lay off dairy a bit, and definitely all sweet products...eat only for health. It can be boring, but she wants to get ahead of this. She doesn't want to be like me - struggling for 15 years, nearly died having my middle boy because blood would not clot because I would not absorb iron or potassium. She will need to be proactive and demand answers. I took the old "get some iron tablets and take them for six weeks" or "we'll do a couple of months of B-12" shots, same old same old year in and year out not getting better for far too long.

 

At least her hemoglobin is good. I'd give my right arm to stay above 10 for more than a couple of months at a time. It is getting better. I turned out to be wheat intolerant, but without typical allergic symptoms. Now that my gut is healing, I am able to absorb more.

 

Faith

[Tiffnkids]

Thank you so much, Faith!

 

DD eats a lot of iron heavy foods. When the PA handed her a printed list of foods dd should eat, dd told the PA "this IS what I eat, I love beans and spinach"! She also eats very little dairy - if she eats cereal for breakfast, she eats it dry; she doesn't really drink milk, cheese occasionally on a sandwich or in lasagna or something.

 

She does take supplemental C, will look into the extra B, chromium P, and acidophilus.

 

I think I will have to call the Dr. and ask for (demand?) additional testing.

 

I am sorry you have struggled with iron issues. Sounds very scary. Thank you for sharing your experiences and knowledge.

[Harriet Vane]

I would be VERY concerned about this. A transfusion may well be appropriate--I am surprised they didn't suggest it to you. They are recommending the right dosage for the longer term, but I think she needs a boost immediately.

 

Also, be aware that it will take a loooooooong time to see normal iron levels. When my ferritin was low, it took about eight months of aggressive supplementation to get my numbers at the very bottom of the normal range.

[BlsdMama]

Vitamin C increases iron absorption, calcium decreases absorption. Stay away from milk. Increase broths, red meat. Strangely, paying attention to magnesium food can help with iron too.

 

Check out whfoods.org

 

Chlorophyll, spirulina, kelp. Floradix iron and herbs. Not all iron is absorbed at the same rate. Often the prescription stuff can leave a person feeling I'll, constipated, or having problems and it isn't well absorbed! If it was my child I would do Floradix, a tea with nettles, alfalfa, and rose hips, and I would supplement with spirulina.

[lailasmum]

I've been through this myself. It's exhausting. I personally found I don't seem to get the boost from eating greens but from really piling on the red meat. The supplements are obviously a major thing that will help but I did some research and found a less side effect causing equivalent iron supplement. You can find out the elemental iron in things by googling.

 

The other thing I've found helped is a really good quality multivitamin. Not just a cheap one off the supermarket shelf but one that has a big range of vitamins and minerals and quite high dosage. It has made a massive difference to my stamina. I come to conclusion I just don't seem to absorb some things that well.

 

I usually find a small effect fairly soon after taking iron supplements like after a few weeks but then it takes like a year of supplements to get on top of it.

[Ann.without.an.e]

My sister has pernicuous anemia and she struggled for years. The only thing that has helped is a gluten free and dairy free diet. Iron supplements alone never made a difference :(

[Seasider]

I agree with lailasmum, a good multivitamin is important. My body responds best to the ones with green foods included.

 

I battled this for years. It took a surgical procedure to get my numbers back into the normal range (but if your dd's cycles are truly light that's not likely the problem, plus she's still in childbearing years). I learned that I also have a low iron-binding capacity (this varies for everyone) and have to always keep an eye out for the creeping return of anemia symptoms.

 

Supplementing is tough on the digestive system and it takes a while to catch up. Others have recommendations for gentle supplements, but for me it took aggressively doing it the hard way. I was on about 1000mg daily. I avoided dairy and added C to help with absorption. Added steak (i would go out to lunch once a week by myself because I couldn't put it in the grocery budget for the whole family regularly enough!). Also, caffeine inhibits iron uptake so cut that out as well. I got my numbers up, but the docs finally told me I was fighting a losing battle if I didn't stem the blood loss. A cervical ablation did the trick, but I still supplement (much less than 1000mg daily!) when I start to drag. Through all of this I had to take the supplements with food to avoid nausea, and I had to add a fiber supplement to my routine to keep things moving. Konsul was recommended by my internist. Kalanamak (miss her - she would have been able to really give you good advice here!) seemed to recommend Miralax and believed it was good stuff.

 

My doc did do bloodwork to rule out other things - leukemia and lupus are the scary ones I remember. My mom also battles anemia. She had an endoscopy which revealed two digestive tract lesions that were sources of constant blood loss. While your PA may not want to do a scoping procedure, I would think at least a check for blood in the stool is in order.

 

Find the cause or she'll be battling to treat the symptoms for the rest of her life.

[Tammyla]

Cream of Wheat has a lot of iron in; if she can tolerate it.  My midwife recommended eating it when I was expecting my second.

 

I hope their rec is helpful and she is feeling better / peppier soon.

[trulycrabby]

Is she an athlete or dancer? Heavy, intense exercise can cause the breakdown of red blood cells.  

 

Ferralet was helpful for me; it's a carboxyl iron with a stool softener. Also the dietary recommendations are good, esp. about the red meat; also bone broth with marrow (crack the bones before boiling)

 

How was the rest of her bloodwork? WBC'S? Platelets? Did they do a thyroid test? Hypothyroidism and anemia can be related, but it's more often seen in older women than your daughter. 

 

If you can get her to eat red meat every day, then do so! I get free range, organic ground beef or bison, make up a bunch of patties, cook, and eat one every few days when my iron and/or ferritin get low. 

 

 

[sbgrace]

Beans and spinach contain iron, but also block absorption. Eggs are horrible for iron blocking. Red fruits, seeds/nuts, other greens, etc. inihibit too. So ignore the food lists the doctor gave you. High iron doesn't mean it's good for building iron stores and, in fact, can be the opposite (in the case of eggs for example--even the yolk is highly inhibitory). Outside of red meat if she wants, use an iron supplement with vitamin C. I'd use Ferrous Bis-glycinate. It's absorbed at least 3x better than the non-chelated forms of iron. Gentle Iron by Solgar is that bisglycinate form and, at least around my area and online, widely available.

[Tiffnkids]

Thank you everyone for the helpful replies. You ladies have a wealth of knowledge!

 

I put in a call to the dr. office this morning. Hopefully, they will return the call.

 

Some additional info: dd is not a dancer or athlete (not enough energy to even try), all other bloodwork was within the normal range except creatinine was low which I was told just indicates very efficient kidneys. No thyroid test. She is a healthy weight for her height (5'9", 134 lbs).

 

DD is taking two classes at the community college (these end next week), works about 15 hours a week at a restaurant (bussing, running food, etc), and is in rehearsal for a play(once or twice a week for now, but will increase in August). She wants to do these things and somehow manages, but when she is home she just sleeps. Maybe she should cut back until she is feeling better? Right now I kind of just want to keep her home and force feed her liver and kale smoothies ;)

 

I have a lot to read about. Thank you for giving lots of great information.

[sbgrace]

Just don't do the Kale! Force feeding the liver and oranges would be better (ick..)! It's primarily the oxalates in Kale (though I think it's got a lot of calcium too).

[Hen]

I am chronically anemic, and don't know why. my lowest record was a 9 and my dr. threatened iron shots if I didn't get it up quickly and then after that transfusions. I am surprised your Dr. isn't being more agressive about this. Anemia can be serious, and can cause heart problems.

 

someone here on this board recommended taking raw liver, freezing it and then cutting it up into pill size bites, and swallowing it whole like a pill once or twice a day. I haven't gone this route, since my anmemia is not so bad, but it is something you might want to consider- or at the very least, adding it cooked to her dinner menu.

 

I do a good prenatal vitamin, which has more iron then regular daily vitamins, plus iron pills and then I take an herbal children's stool softener when needed (not a laxative, learned the hard way there is a difference between softener and laxative, ugh!)

 

nettle tea, and also some people take a spoonful of dark molasses everyday, and also you can cook everything in a cast iron pan, that will pass some of the iron onto the foods.

 

I hope she feels better, and I hope you push for an answer. After about 20 years of constantly being anemic, I'm kind of fed up with not knowing why and now that I have a new Dr. and new insurance, I'm going to push for an answer.

[Shellydon]

Floradix works really well.

[Bree]

I always struggle with low iron and exhaustion I was always stuffing myself with the iron rich foods but it never seemed to help much :( One thing that really helped me was finding I had a Candida overgrowth so I went on a Candida diet and added probiotics to my diet. Pretty much eliminated grains and sugars from my diets and upped my proteins. The first time in my life I actually had energy and my iron levels went up.

[mamaraby]

Non-heme forms of iron can be helpful (kale is better than spinach), but they need to be consumed with vitamin c and beverages like tea/coffee should be avoided within an hour before or after a meal because they contain compounds that inhibit iron absorption. And yes, cast iron pans can help too. You'll get additional iron if you cook something acidic in them. More info - http://veganhealth.org/articles/iron#abs - should she prefer plant based options.