Anemia question - scared

For the past few months, my iron bloodwork has been low and I'm having trouble understanding the results. In July, my bloodwork was normal, but my iron serum and transferrin saturation was low (iron serum was 30 and saturation was 8%). Hemataologist did 4 weeks of IV infusion (Ferracet?) and bloodwork is now worse. Iron serum is now 27, saturation is 8%, TIBC is normal and ferretin jumped from 35 to 135. However, hemoglobin dropped from 12.5 to 11.7. Hematocrit dropped from 37.5 to 34.5. RBC are now 3.9 and low MCV. What does this mean? I am a 45 yo female. Taking BC pills continuous so no bleeding and no other bleeding that I know of. Only symptom is tiredness.

[Dr. Kokil Mathur]

Hi!
To assess a patient’s iron status, measurements of iron, TIBC (total iron binding capacity) and measurement of ferritin are performed. Transferrin is a substance that transports iron in the plasma. If the saturation is below 20%, the amount of iron carried by transferrin is decreased. In this situation it is also expected that the absolute serum iron will be low. Normally in iron deficiency, iron is low, TIBC is high, percent saturation is low and ferritin is low. The iron can be low due to poor diet or due to inability of gut to absorb iron as seen in malabsorption syndromes, IBS etc.
The cause of iron deficiency anemia will need to be found. The three main causes of low iron are—poor intake, poor absorption, and high loss. Poor intake can be compensated by diet rich in iron and iron therapy. Poor absorption is seen in conditions like Crohn's, IBS, severe acidity etc, and needs to be ruled out. High loss is seen there is a bleeding in your gastrointestinal tract, either due to esophageal varices, polyps, gastric bypass site, hemorrhoids or an ulcer. You should get your stool examined for occult or hidden blood to detect this blood loss. Also you need to get a pheripheral blood smear done to know the RBC count, structure and whether there is cytopenia (general decrease in cell count). The renal function and liver function needs to be checked, and electrophoresis of hemoglobin done to know whether there is thalasemia trait or sickle cell anemia. You need to see if there is vitamin B12 deficiency. Once the cause is found and corrected, then the lost iron is replaced by iron therapy, either in form of pills, capsules or syrups, or as injectable preparations. Consult your PCP regarding this. You should ideally consult a hematologist for this. Do discuss this with your doctor and get yourself examined. Take care!