Supplements And Iron Deficiency?


Aug 8, 2014

Since my symptoms started over two years ago (I was 22), I have lost 70% of my hair. My iron status at the onset of symptoms:

Hemoglobin 13.5 (11.7-15.5)
Hematocrit 39.3% (25-40)
Iron, total 160 (4-175)
Ferritin 18 (10-154)

After supplementing with 150mg of elemental iron for 6 months (per a dermatologist that diagnosed me with telogen effluvium and advised that I increase my ferritin to 70-80 to stop hair loss):

Hemoglobin 13.1 (11.1-15.9)
Hematocrit 39.6 (34-46.6)
Iron, total 103 (35-155)
Ferritin 62 (13-150)
Reticulocyte count 0.6 (06-2.5)

After supplementing with 100mg of elemental iron for about a year after that:
Hemoglobin 13.9 (11.1-15.9)
Hematocrit 42.0 (34.0-46.6)
Iron, total 82 (35-155)
Ferritin 59 (15-150)
Iron saturation 28% (15-55)
TIBC 291 (250-450)
Reticulocyte count 0.4 (0.6-2.6)

I stopped taking iron supplements because I was not getting better, and because I had a few doctors tell me that I should not be on iron supplements because my hemoglobin, hematocrit, MCV, and RBCs were in the normal range. So I stopped for 3 weeks. Yesterday, I had a ferritin test done with a result of 87. This makes absolutely no sense considering I have not taken an iron supplement.

A physician I saw theorized that I could possibly have anemia of chronic disease, due to a low reticulocyte count, low TIBC and normal MCV. But that doesn't make sense to me either because although my ferritin did increase for some strange reason, it was on the low side before I started supplementing. And, my RBC, hemoglobin, and hematocrit have always been in range, and do not vary much despite supplementation.

I'm nervous that I shouldn't be supplementing with iron. In addition, my TSH (3.3), and midrange FT3 and FT4 have not changed despite supplementation--one physician theorized that maybe if I increase my ferritin levels, my thyroid levels will get better and I will stop losing my hair. Also, when I went on Naturethroid (went up to 2 grains over 6 months), my TSH decreased, but my FT3 and FT4 did as well--I felt awful.

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Iron Deficiency Anaemia - Hb 3.7

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After noticing a recent decrease in my athletic performance, I sent a message to my doctor early last week. My primary care physician ordered blood work and sent me to a hematologist in oncology. The hematologist said it was "very unlikely" cancer and ordered more blood work. Further blood work confirmed I have iron deficiency anemia.

All my blood work was normal apart from the indices related to iron deficiency. Ferritin was low, indicating iron deficiency and not anemia of chronic disease. Bone marrow is producing a normal amount of red blood cells. I have not recently donated or lost substantial quantities of blood. I have not had any tarry stools or seen blood in my stool. A rectal exam was negative for the presence of blood. (This test involved a doctor inserting a gloved finger into my rectum and then testing the glove for blood.) I have no bruising and my blood clots normally. I have not seen any blood in my urine. I have no other ongoing health conditions.

For the last 5 years, I have run 52 miles a week. I eat very little red meat, no more than a few times a year. I do regularly eat poultry, fish, and eggs. I have had semi-frequent nose bleeds, averaging one a month, since childhood.

The hematologist put me on a high potency iron supplement -- 130mg of iron and 250mg of vitamin c per day.

All my doctors have discounted the possibility the anemia could have been caused by my running, despite there being ample evidence in medical journals that excessive exercise can lead to iron deficiency.

If it's not cancer and i'm not losing blood through my gastrointestinal tract, what is causing it? I do feel improved since starting the iron supplement on Monday, but my athletic performance is not where I'd like it to be. I don't have any further doctor visits scheduled at this time. I am to have blood work in 1-2 months to test my iron levels again.

My blood work is below:

IRON 24
TOTAL IRON BINDING CAPACITY 380
IRON/TOTAL IRON BINDING CAPACITY 6%
FERRITIN 5.6
VIT B12 549
FOLATE 17.62
RETICULOCYTE COUNT, ABSOLUTE 2.5

WBC'S AUTO3.4
RBC, AUTO4.52
HGB 10.6
HEMATOCRIT34.2
MCV 75.6
MCH 23.5
MCHC 31.0
RDW, BLOOD18.0
PLATELETS, AUTOMATED COUNT 206
MPV 8.7

CHOLESTEROL 127
HDL 43
CHOLESTEROL, NON-HDL 84
TRIGLYCERIDE 48
LDL 74

HGBA1C 5.4

GLUCOSE POST FAST 87
BUN 21
CREATININE1.2
TOTAL PROTEIN6.6
ALBUMIN 4.8
GLOBULIN1.8
ALBUMIN/GLOBULIN RATIO, SERUM/PLASMA 2.7
CALCIUM 9.4
AST 21
ALKALINE PHOSPHATASE 51
BILIRUBIN, TOTAL 0.8
LDH 157
PHOSPHATE, BLD, QN 4.2
URIC ACID5.3

TSH,BLD,QN1.680

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Ferritin, Serum- 7 (15-150)
TIBC- 415 (250-450)
UIBC- 368 (150-375)
iron saturation- 11 (15-55 %)
iron, serum- 47 (35-155)
rbc- 4.93 (3.77-5.28)
hemoglobin- 11.5 (11.1-15.9)
hematocrit- 37.5 (34.0-46.6)
mcv- 76 (79-97)
mch- 23.3 (26.6-33.0)
mchc- 30.7 (31.5-35.7)
rdw- 17.1 (12.3-15.4)
platelets- 317

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I initially found out I had mild iron deficiency about 6 months ago and the GP didn't tell me to take anything. I've been taking floradix on/off (finished a bottle) and redid my blood work with a new GP. The results seem to have gotten slightly worse, but this new GP also just recommended to take a multivitamin. Neither doctor seemed concerned. Anyway, here are the latest results (this new doctor didn't test ferritin; my old result 6 months ago was a 3)

Hemoglobin - 11 (low)
MCV - 78 (low)
MCH - 25.2 (low)
RDW - 15.6% (high)
TIBC - 538 (high)
UIBC - 480 (high)
Iron Saturation - 11% (low)
Iron Serum - 58 (normal)
Vitamin B12 - 348 (normal)

Anyone know exactly how bad my case is? I am located in NYC; if anyone has a good doctor that takes iron deficiency more seriously, can they recommend the doctor?

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- breathlessness

- extreme fatigue

- lingering anxiety

- muscle weakness

- muscle stiffness

- occasional numbness

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These are the most common ones and I don't always experience all of them. Also it's like I always feel a need to warm my body with warm water bottles and such. It's gotten to the point I never leave my bed even when I feel better because I'm afraid I might feel unwell. And I know this is so bad because on top of everything my body is getting deconditioned, but I can't make myself do it because I get so anxious.

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RBC 5.45 (4.00-5.36)
Hgb 12.5 (12-16)
MCV 74 (81-98)
MCHC 30.9 (31.2-35.2)
RDW 24.2 (11.0-14.5)
anisocytosis present
hypochromasia present
ovalocytes present

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The GYN looked at these labs and said this is NOT anemia. She then ordered an iron panel, which she said was normal:

Iron 142
TIBC 356
Ferritin 14

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Here are my lab results:
WBC 6.6 (4-10.8)
Ly 25.8 (20.5-51.1)
Mo 9.7 (1.7-9.3)
Gr 64.5 (42.2-75.2)
Rbc 3.74 (4.2-6.1)
Hgb 10 (12-18)
Hct 30.3 (37-52)
Mcv 80.9 (81-99.9)
Much 26.8 (27-31)
Mchc 33.1 (33-37)
Rdw 14.5 (12-15)
Plt 218 (130-400)
Mpv 8.2 (5-10)

My iron and ferritin were normal (don't have a copy of the results, just was told they are normal). Also, b12 and d are normal.

What kind of anemia does this look like? I DO have a history of iron deficient anemia, but my ferritin was like a 3.

Below are my symptoms. Saw the doc about a week ago, and symptoms are much worse than then. I am on an iron supplement.

Extreme exhaustion
Weakness
Shortness of breath
Chest pains
Extreme lightheadedness/dizzy spells/near syncope

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Does this not seem crazy for a hgb of 10?? I have been in the 8 range, and while I felt really, really bad, I was not this dysfunctional.

Also, I have been having the dizzy spells/lightheadedness/near syncope and some actual syncope for over a year. The drs are still trying to figure this out. They are a good deal worse right now.

Any thoughts or advice?

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