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Fri Apr 15, 2022, 09:31 PM

Iron deficiency anemia...need to learn about this.

My SO has this, severe loss of breath and other symptoms. Just got home from 2 days in hospital, they did a transfusion and gave her iron IV and home now taking Ferrous Gluconate Tablets 324 mg twice a day.

The blood test numbers are:

RBC 3.29 L (went up to 3.67 after hospital visit and transfusion and iron IV)

Hemoglobin 7.1 (went up to 8.4, normal for her in the past 14.0)

Hematocrit 25.6% (went up to 28.6% post hospital)

Ferritin 3 (no further testing)

NT-proBNP 567 (went down to 426)


Not sure what other numbers I should provide, I have tons of tests here. Hoping someone here can give me their experiences and other than red meat and other known high iron foods, what are you doing to get better?

I guess if the hemoglobin number is under 8 you shouldn't fly without supplemental oxygen? We have a trip soon, not sure what to do.

Gladly accept any input, it is all new to us. Thanks...(CRAVES ice and chews on it all day)

PS
Of course we are following up with docs and more tests and will ask many questions, just thought I would talk to folks about experiences.

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Arrow 28 replies Author Time Post
Reply Iron deficiency anemia...need to learn about this. (Original post)
Eliot Rosewater Apr 2022 OP
PoindexterOglethorpe Apr 2022 #1
Tetrachloride Apr 2022 #2
Eliot Rosewater Apr 2022 #6
Tetrachloride Apr 2022 #9
Eliot Rosewater Apr 2022 #12
Warpy Apr 2022 #3
Eliot Rosewater Apr 2022 #5
Warpy Apr 2022 #11
Eliot Rosewater Apr 2022 #13
Warpy Apr 2022 #18
mahina Apr 2022 #4
Eliot Rosewater Apr 2022 #10
woodsprite Apr 2022 #7
Eliot Rosewater Apr 2022 #8
Grasswire2 Apr 2022 #19
hlthe2b Apr 2022 #14
Eliot Rosewater Apr 2022 #15
hlthe2b Apr 2022 #16
Eliot Rosewater Apr 2022 #17
Grasswire2 Apr 2022 #20
Grasswire2 Apr 2022 #21
Patterson Apr 2022 #22
elias7 Apr 2022 #23
Eliot Rosewater Apr 2022 #24
elias7 Apr 2022 #25
Eliot Rosewater Apr 2022 #26
elias7 Apr 2022 #27
Eliot Rosewater Apr 2022 #28

Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 09:34 PM

1. I'm aware that this is somewhat more common than people might realize.

But ask your PCP or a nurse about specifics, especially about travel.

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Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 09:42 PM

2. Vitamin C may need to be checked

as a supporting factor .

Note: high levels of red meat may encourage situations of gout. Good news: citrus will alleviate gout which I can anecdotally attest to. so now there are 2 key reasons to have citrus.

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Response to Tetrachloride (Reply #2)

Fri Apr 15, 2022, 10:04 PM

6. We chew those 500mg from Costco each daily.

So you are saying Vit C is helpful here, I assume. Thanks.

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Response to Eliot Rosewater (Reply #6)

Fri Apr 15, 2022, 10:12 PM

9. Right. but real citrus fruit is part of the way to reduce to gout

if it occurs, plus more water

good luck

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Response to Tetrachloride (Reply #9)

Fri Apr 15, 2022, 10:13 PM

12. OK

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Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 09:45 PM

3. Your numbers are caca but not incompatible with life

They will try to iron tablets first. Ferrous gluconate has fewer GI side effects beyond black shit. If it does upset your stomach, try over the counter Slo-Fe, it's timed release and I've never met anyone who's reacted badly to it.

As for flying anywhere, you will need supplemental oxygen with those numbers. Aircraft cabins have the same pressure as 8000 feet in altitude, meaning people with anemia won't get enough oxygen carried by their depleted red blood cells and can run into trouble. Call your airline and see if they have/rent oxygen setups for passengers with health issues. You might need to collect a prescription for it if the charge is substantial, it can be reimbursed. If uou need to organize your own, most medical supply stores rent them. Again, you'll need a prescription.

(Note I didn't mention pernicious anemia, I'm guessing your B-12 levels were checked)

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Response to Warpy (Reply #3)

Fri Apr 15, 2022, 10:00 PM

5. Thanks B12

VITAMIN B-12 398 pg/mL is the number and I guess safe range is
193 - 986 pg/mL


Thanks for the oxygen tip, we will ask doc for that.

AS to

Slow Fe, High Potency Iron 45 mg, Slow Release - 60 Tablets

On Amazon the prices seem to vary a bit...this is 45 mg and is taking 324 twice a day. This is sulfate not gluconate? The difference is ?

Would one expect which numbers to improve how much with iron supplements? The caca remark is concerning, but I also thought they didnt look good. They did a scan of abdomen looking for bleeding, didnt find any.

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Response to Eliot Rosewater (Reply #5)

Fri Apr 15, 2022, 10:13 PM

11. The differrence is that Slo-Fe is released over many hours

and is tolerated better by people who get bad digestive upset from iron gluconate. Few do. If you do, ren it by your doctor as to your dosage.

Sorry if that wasn't clear.

Remember, black poo is normal no matter what sort of iron supplement you are on. It's a feature, not a bug.

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Response to Warpy (Reply #11)

Fri Apr 15, 2022, 10:14 PM

13. Thanks again.

Is this something you know about as in you or a family member and if so what would a person expect to improve those numbers to by taking the supplements, etc?

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Response to Eliot Rosewater (Reply #13)

Fri Apr 15, 2022, 10:35 PM

18. Personal experience followed by RN experience

the latter being sadly out of date, but some things don't change all that much.

The biggest pill bottle I've ever seen was when I was put on iron four times a day for a hematocrit quite a bit lower than yours. I have a rare blood type and it was the holidays, so no transfusion for me.

I was fine within a month.

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Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 09:52 PM

4. I broke many teeth chewing ice

Nobody tells you not to do that, at least nobody told me, but she shouldn’t be chewing on that. Root canals, implants cost 6k per tooth + pain.

Don’t chew ice.

Good luck with that anemia! Thanks for sharing the information that you can.

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Response to mahina (Reply #4)

Fri Apr 15, 2022, 10:12 PM

10. Thanks, mentioned it.

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Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 10:06 PM

7. I was close to needing a transfusion before surgery

My levels were just hanging around 8. Besides red meat, sardines, oysters, and salmon, they told me to eat spinach (but make sure I had some citrus or oj at the same meal), beets, and add a couple of tbsp of black strap molasses to my daily intake, if possible.

Hope she feels better soon.

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Response to woodsprite (Reply #7)

Fri Apr 15, 2022, 10:07 PM

8. Thanks

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Response to woodsprite (Reply #7)

Sat Apr 16, 2022, 12:13 AM

19. But if there's gout involved (just a caution)...

some of those things are the wrong thing to eat... Red meat, sardines, oysters, salmon, other fish all verboten.

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Response to Eliot Rosewater (Original post)

Fri Apr 15, 2022, 10:15 PM

14. You may need to learn to be highly agressive in advocating for your spouses care (and I'm a primary

Health Care Provider). In the area of chronic anemia, you should know that veterinarians routinely provide better care than many in human medicine in the treatment of chronic anemia from cancer, autoimmune disease, iron anemia and other chronic conditions. Their stand of care is far more responsive to drops in hemoglobin and hematocrit for animals with similar conditions than are ER physicians and even primary care, even with cancer patient (oncologist) orders. in the area of "Cadillac" veterinary care, they often surpass those of us in human care. Seriously. I am sad to admit.

It is the case that a human patient may be allowed to be far lower in their hematocrit and hemoglobin before a transfusion is ordered than a canine patient with cancer or autoimmune condition. As one with colleagues in both fields, I can attest to this. You MUST advocate for the care. I'm sorry to say this, but I've observed it firsthand.

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Response to hlthe2b (Reply #14)

Fri Apr 15, 2022, 10:18 PM

15. Thanks, we already noticed that there didnt seem to be much offered other than

the supplement but we havent had the GP follow up yet.

The cause is bleeding sometimes I guess and if not bleeding from abdomen where else could it be, I wonder. Or it is just a condition that has no acute cause like that.

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Response to Eliot Rosewater (Reply #15)

Fri Apr 15, 2022, 10:21 PM

16. Bleeding and failure to absorb. The latter is a MAJOR issue in terms of supplemental iron some

for which SOME are almost useless given the lack of absorption. Really. Do your own homework and be an aggressive advocate.

This is an area for which I get VERY antagonized by my colleagues and thus have ZERO problems pointing out that the best in veterinary medicine often have it ALL over us in terms of standard of care for those conditions.

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Response to hlthe2b (Reply #16)

Fri Apr 15, 2022, 10:25 PM

17. Will do!

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Response to Eliot Rosewater (Original post)

Sat Apr 16, 2022, 12:16 AM

20. I was just diagnosed with iron deficiency anemia.

My score is twenty, though, not as bad.

Not looking forward to any pill that makes me feel bad.

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Response to Grasswire2 (Reply #20)

Sat Apr 16, 2022, 12:17 AM

21. it might explain my tinnitus.

That has been a problem lately.

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Response to Eliot Rosewater (Original post)

Sat Apr 16, 2022, 01:14 AM

22. 7.1 hemoglobin is time for a blood clot d transfusion. 8.4 might be. Get her to a hematologist

if she’s not already seeing one

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Response to Eliot Rosewater (Original post)

Sat Apr 16, 2022, 06:34 AM

23. New iron deficiency means blood loss. First, rule out colon cancer, upper GI bleeding from NSAIDS

Physician here. With no history of anemia, and given IV iron and discharged on iron supplements, I must assume your SO’s bloodwork was consistent with iron deficiency. They must have checked stool guiac for occult blood in hospital and should arrange a colonoscopy pronto if they haven’t already, unless there is some other reason for chronic occult blood loss - upper GI bleeding/ulcer/gastritis from regular NSAID use, chronically heavy menses, renal or bladder cancer, other…

Poor absorption from proximal GI tract (duodenum, jejunum) is an uncommon cause and would primarily occur in setting of previous upper GI surgery or chronic inflammatory conditions, which I’m sure they asked about and you would have been aware of.

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Response to elias7 (Reply #23)

Sat Apr 16, 2022, 11:54 AM

24. Thank you for responding, she had a colonoscopy right BEFORE the symptoms started...

They did an abdominal scan in hospital last week and nothing.

Could the colonoscopy have started a bleed during the process of that, and it could still be bleeding and if so how would they check that? Yes all bloodwork is consistent with iron deficiency, i posted some of it here and I have tons other that I could post but I dont know what to post to show you, but yes.

Below numbers were after first test in hospital beginning of last week, then the last test before they sent her home:

RBC 3.29 L (went up to 3.67 after hospital visit and transfusion and iron IV)

Hemoglobin 7.1 (went up to 8.4, normal for her in the past 14.0)

Hematocrit 25.6% (went up to 28.6% post hospital)

Ferritin 3 (no further testing)

NT-proBNP 567 (went down to 426)

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Response to Eliot Rosewater (Reply #24)

Sat Apr 16, 2022, 01:09 PM

25. How long ago was the colonoscopy?

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Response to elias7 (Reply #25)

Sat Apr 16, 2022, 11:35 PM

26. March 22 of this year

Not even a month ago.

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Response to Eliot Rosewater (Reply #26)

Sun Apr 17, 2022, 05:29 AM

27. If she had a biopsy or a polyp removed,

that would be the most common source of bleeding post colonoscopy. The dramatic symptoms - severe shortness of breath - does in part suggest acute/sub-acute blood loss, as slower blood loss over say 6-18 months would give a person time to adapt physiologically.

If she had GI losses post colonoscopy, she would have noticed reddened stools, somewhere between bright red and dark maroon. For the hospital to test for various forms of anemia, however, would suggest that the cause of anemia was not clear.

The BNP is a typically an adjunctive measure of heart failure, used in conjunction with the chest X-ray to determine if someone’s shortness of breath is caused by cardiac decompensation. Sounds like the value was normal, so not sure it was rechecked. Low hemoglobin can stress the system since she has markedly decreased oxygen carrying capacity, causing heart attack (MI) or congestive heart failure (CHF), but this usually happens in the setting of pre-existing heart disease.

Ferritin stores are very low, suggesting the process has been going on for more than just a few weeks though. If there is no reason for iron malabsorption - precious upper GI surgery/resection, chronic GI inflammatory condition - you’re looking at finding the reason for insidious blood loss.

Often, anemia is multi-factorial, so for example, it is incumbent on your docs to determine if the anemia is a combination of iron deficiency and anemia of chronic disease (acd), and find the reason for this.

What are your docs thinking is the cause of her iron deficiency?

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Response to elias7 (Reply #27)

Sun Apr 17, 2022, 07:44 PM

28. Thanks again...

They dont know, I dont think, but I was not there the day she had her last visit with the attending physician before discharge and she doesn't remember everything. Tuesday she sees her GP and they will have the notes and tests from the hospital as it is all the same system, so will find out more then.

I wondered if the CLN itself could have caused bleeding (had 2 polyps removed) that resulted in this since it was only a month ago, but if she was bleeding from the colon it would be in her stool AND would it have shown in the abdomen scan? I dont know if that would be visible or WHERE else could she be bleeding NOW that causes this that could be screened by another CT if anywhere?

Thanks again...

(I dont think she has noticed red or black or blood in stool between CLN (3-22) and hospital visit (4-11 to 4-13.) And as to now, or since hospitalization, she doesnt know because she has been plugged up which is common for her.

Which reminds me, we read that someone who uses stimulant laxatives on a regular basis, and we both do, can develop this issue as a result of the lack of absorption of the iron.

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