Dr Hive -- help please with anemia/iron-deficiency?

[saw]

I would really appreciate some suggestions on this. DD, 16, has been tired for several months. We had several rounds of bloodwork until a Dr ordered a ferritin level test, which came back low (11). DD took double doses of iron supplements for two months, retested, and ferritin came back at 13.8. Haemoglobin and iron were both normal.

She went back to the doctor today for more testing. Iron was low (4.8), ferritin 10.8, and haemoglobin normal. Vitamin D was low (20 where normal is 30 to 100). She's going to have to have more testing to figure out what's going on, whether it's malabsorption or blood loss. It's unlikely to be diet or non-compliance with the iron pill regime. She also has an identical twin sister who has none of these issues, which makes me think it isn't likely to be something that's just weird about her but normal, IYKWIM.

 

Does anyone have suggestions for things I need to look into? Ideas? Experiences? It's a weird situation in that she's doing a school year abroad, so I'm not right there (although, as I've told her, I will fly out there if necessary -- I suspect that she will get better care where she is than here at home). I emailed with the doctor she saw today and he seems very good and inclined to listen to my views as well, which is great. For example, her pulse was irregular, so he immediately ordered an ECG, which was done straightaway. I thought that was quite good.

Any and all help is appreciated!

 

[shawthorne44]

Does she bleed a lot monthly?  As a teenager I bled myself anemic and none of the male doctors thought to ask about that.  

[Joker]

My 14 year dd is also anemic and on iron supplements. The doctor thinks she will also need birth control pills to lessen the bleeding during her cycles, though, because it is so heavy and the supplements/good diet just can't replace what's being lost.