Tiredness and Low Iron Count

[alexandria]

Looking for some advice. I am a 36-year old female with a history of severe IBS and chronic constipation, high blood pressure, asthma and endometriosis. In mid January, I was diagnosed with low iron. My CBC was normal, but my iron count was 20 and my iron saturation was 3 (I'm told that a normal count is 30-35 and the normal saturation should be about 15). My doctor was not sure of the cause (I do not have periods due to long-term treatment for endometriosis - continuous BC pills and thyroid and other blood tests have been normal). Only thought is that I was put on Senekot last June for about 6 months to treat chronic constipation (after all other methods failed). There was a period of about 6 weeks where the Senekot produced mild daily diarrhea. Not sure of this could be the cause. Diarrhea stopped after medication was changed. Following blood work in January, doctor put me on oral iron (Slow FE, 1 tablet per day). I was retested in early March and the levels had not increased significantly. CBC was fine, hemoglobin was fine, total iron count was now 22 and saturation was 4. Doctor didn't seem concerned, although I have been complaining about mild tiredness. He raised my oral iron to 2 tablets of Slow FE per day and told me to get blood retaken in July. My specific questions are as follows:

1. I have experienced mild tiredness during this time. I'm able to excercise without problem, but seem to get tired following normal activity or exertion. I haven't gotten much exercise this winter, so my body could be readjusting, but not sure if tirednes is due to low iron. (Note, I've also increased my intake of green vegetables and added vitamins with iron).Is mild tiredness common with low iron?

2. Is there any reason the iron levels have not increased siginificantly?

3. Is 3 months too long to go before retesting to ensure that my oral iron is enough?

4. What would you recommend if I retest in July and the levels are still below normal?

[Kevin Pho, MD]

To answer your question:
1) Yes, fatigue is common with low iron levels.  However, you may want to confirm the diagnosis.  You may want to consider a ferritin level.  Typically, the iron saturation is high, not low, with iron deficiency anemia.  

2) Cases where one does not respond to iron therapy can be seen in i) people where iron deficiency is not present (i.e. wrong diagnosis); ii) iron deficiency caused by blood loss; iii) the iron tablets may be enteric coated.  

3) Typically iron levels should rise within 3 weeks of treatment.

4) I would recommend retesting to see whether you are iron deficient at all.  This would include a ferritin level, and possible consideration of a bone marrow evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[alexandria]

Thank you for your comments. Can you tell me if there are other causes I should exploe that would explain a low iron count (where anemia is not present)?

[stinasmom]

Make sure of what kind of anemia you have. Lack of B vitamins do the same thing.

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