Abnormal Labs Please Help

Hello everyone,

I don't post often, but I could really use advice/opinions from my fellow RNY peeps. Here is a brief background. I am 31yrs old and had RNY January 2010. I started at 353 pounds and have stayed between 195-200 pounds. I've been doing great until I had my labs drawn last Thursday. The weekend prior I was so physically drained I found myself falling asleep at work, over sleeping in the morning and actually getting a full nights sleep, which never happens. I made an appointment with my PCP for another issue and told her what else was going on and asked to have my labs rechecked. They were last checked in January.

The labs were back the next day and I was horrified to say the least. So many of my "symptoms" were finally explained. Achy body, restless legs, constantly feeling cold etc. Here are the results:

 

WBC: 9.07

RBC: 4.19

Hemoglobin: 9.7 (Range of 12.0-15.0)

Hematocrit: 31 (Range of 35-45)

MCV: 75 (Range of 80-99)

MCH: 23 (Range of 27-34)

RDW: 15.9 (Range 9.0-14.5)

Platlet Count: 470 (Range 140-400)

The biggest surprise of all, and to quote my doc, "Your ferritin is almost non-exsistent" Which is a 4. (Range of 20-200)

 

She started me on an iron supplement and wants to recheck in 1 month. I don't want to overstep her decision, but is it safe to wait a month? She did mention an infusion, but she wanted to try the iron supplement first. I'm feeling overwhelmed with all these results/numbers, has anyone else been through this?

 

Amanda

What's your iron level?  I didn't see that one.

Yeah, your ferritin is super super low.  Were you not on any iron until now? 

How much iron and what type did your doc recommend?

Personally, I think if my ferritin was that low, I would see a hematologist to talk about infusions.  I would take big doses of iron orally as well, because I would hope to not have to do infusions forever, but I'd talk to a hematologist about an infusion if my ferritin got below 10.

I don't see any point in doing labs sooner than one month because it will take time for your ferritin to increase - three months ago my ferritin was 15 and I increased my  iron from 75 mg to 300 mg and after three months, my ferritin is now 26.  I just don't think you'll see mu*****rease in a month, certainly not sooner than that.

Was your ferritin good in January?  What was it then?  It seems it  must have been at least on the low side back then, but if it was good then and has dropped a whole lot in less than one year, I'd be concerned about that.

From all my lab reports I have not had an "Iron Study" done since November 2011.  I also do not see where my ferritin level had ever been checked.

Iron: 66 (Range 50-180)

Transferrin: 281 (Range 206-381)

Total Iron Binding: 337 (Range 204-408)

Total Saturation: 20 (Range 15-50)

 

I have not taken iron by itself, but a bariatric vitamin. Never noticed anything different or off about my body, so I wasn't concerned. She put me on an OTC Iron. Per the bottle: 65mg equivalent to 325mg Ferrous Sulfate. She wants me to take 2 a day with a glass of OJ. Luckily I've not had gastric issues or constipation that I heard commonly happen.

 

Ferrous sulfate is not absorbed real well in us because we don't have enough stomach acid.  We do better with carbonyl iron. 130 mg a day is not that big a dose, either.  You would probably need about three times that much to see a significant increase in your ferritin.

The reason she recommended taking it with OJ is because vitamin C helps with the absorption of iron, but in order for it to help with absorption, you need 200 mg C for every 30 mg iron.  So you'd need about 400 mg C with a 65 mg dose of iron.  However, eight ounces of OJ only has about 100 mg vitamin C.  Unless you take a dose of iron with FOUR glasses of OJ, it's not going to help you absorb it.  You might want to spare the calories and just take a vitamin c supplement instead.

Most likely you need infusions.  It is very unlikely that your iron - ferritin can rebound with just supplements.  But sometimes that helps. 

(but I doubt that).   You may need to go that route - but I hope that in  month or so - you may get infusions. I had to wait almost one year before finally was able to get infusions.. but my numbers were much better that yours. 

HUGS..  

Hon demand an infusion. Your ferritin is in the gutter and getting that up will be a tough one. Schedule an appointment with a hematologist ASAP. 

 

My my lowest ferritin was a 12 and I was miserably exhausted. I can't imagine a 4. 

Seems like some sort of anemia. I am a nurse and if I saw these labs, I'd be calling a doctor and asking if they want a transfusion. Your hemoglobin is very low. That would explain the weakness and tiredness. I've had doctors let a hemoglobin that low ride but because of your malabsorption it seems that a transfusion might do you some good.

Your blood count would make me want to see a transfusion and then an iron infusion.   I'm not a medical doctor, but my sister had numbers like that and after the gave her a blood transfusion she felt so much better.  AFter that she was able to maintain her iron levels (ferritin too) on a relatively low daily dose.  I take 160mg of elemental iron, which is equivalent to several of those prescription ferrous sulfate pills, because very little of the ferrous sulfate is elemental and absorbable.  My ferritin is rising, but slowly.    I'm sure your PCP is just being cautious, but I really don't like your hemoglobin being at 9.  Most doctors will want to do a transfusion at 7 or 8, so you don't have much room for it to drop.  

I'm sorry you are feeling so crappy.   Were you taking an iron supplement and just not enough, or had you lapsed on taking your vitamins?  No judgment, just curious.  I have been taking mine faithfully and my numbers tanked anyway.