iron infusion therapy

[grizzly]

I am a 70 year old female. I have just come from my 6th iron infusion therapy in 3 years. I had one blood transfusion also during that time. My hemoglobin for the past 2 months is holding at 9.9 but ferritin has dropped from 168 to 11. I have had all the internal tests to eliminate bleeding as a cause, but have never been given an explanation or diagnosis other than my body is not holding onto or making iron. I work full time, of necessity, not choice, in a job I love but still find it quite difficult at times just to find the energy to function. My hematologist is quite busy so really does not do much by way of explanation and before you know it, you're out the door and didn't ask your questions or get any answers. I see him on a 2 month basis. I have tried to research the problem but come up with nothing concrete. I have been advised now to write down all the questions I have and ask for answers at my next appointment. Being a reasonably intelligent person, I can't believe I haven't done this before. If you have any suggestions for me, I would appreciate them.
Thank you.
Grizzly

[Kevin Pho, MD]

There are several reasons for iron deficiency anemia with blood loss being the most common (as you have mentioned).  As for all the "internal tests", I would assume that an upper and lower endoscopy were part of these tests.  If not, then I would suggest obtaining them.

Blood loss — The major cause of iron deficiency is blood loss, either overt or occult. Overt blood loss is, by definition, obvious and not difficult for the clinician to recognize, often by history alone. Examples are severe traumatic hemorrhage, hematemesis, hemoptysis, severe menorrhagia, and gross hematuria.

Occult bleeding, on the other hand, may be difficult to track down. This usually occurs via the gastrointestinal tract in men. Additional factors are often responsible in women, including endometrial bleeding.

Decreased iron absorption — Gastrointestinal malabsorption of iron is a relatively uncommon cause of iron deficiency, although it may be observed in certain diseases associated with generalized malabsorption. An example is celiac disease (sprue), in which there may also be a component of GI bleeding. This diagnosis should be considered in patients with otherwise unexplained iron deficiency.  This can be diagnosed via serum antibodies.  

Other — There are several other uncommon causes of iron deficiency:

Intravascular hemolysis (breakdown of red cells in the blood vessels) can lead to significant urinary iron losses and in cardiac patients with intravascular destruction of red cells secondary to malfunctioning valvular prostheses.

Pulmonary hemosiderosis (a form of chronic pulmonary hemorrhage) can appear as functional iron deficiency.

You may want to consider these diagnoses with your personal physician.  

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.

Bibliography:
Schrier.  Causes and diagnosis of anemia due to iron deficiency.  UptoDate, 2004.

[ozark]

have you been checked for b12 deficiency?

[shellyB]

Hi, I like you have been very anemic for long time. (I am a 41 year old female.) My ferritin was at a 2 for months but since raised to a 6 and has stayed there. I know exactly what it feels like to be so exhausted you can barely function. Because of nothing being done to address my anemia I have swithched HMO's and am now seeing a new physician. I urge you to do whatever it takes to get the medical attention you deserve from your doctor. I have waited and waited and it has not served me nor my family. My old doctor has still not sent my medical records in their entirity so I am still waiting for a referral to a Hematologist. Please keep pushing although I know it is hard when you are constantly exhausted, day in day out. I have been taking very strong B-12, 400mcg which has HELPED ME TREMENDOUSLY! I read about the B-12 on this website. I believe this is what got my iron up from 2 to a 6. I ordered it from iherb.com it cost about $10.00 plus shipping. After taking 1 tablet daily for 2-3 weeks I awoke one morning and felt better. I instantly knew my blood was better and sure enough my next blood test I was up to a 6! It has stayed there but it is much better than 2. Being anemic is a horrible state of sluggishness and it is easy to lose your fortitude when you need it the most. Be strong and please consider the B-12! My heart is with you, Sincerely, Shelly

[z3rockstar]

Hi.  Last week I went in for my first iron infusion.  What sort of side effects are expected or a common or not common when this is done?  Since Last Tuesday I have felt sick, weak and still very tired.  I still don't have any energy and still unable to get up in the morning.  Should this still be happening a week after the infusion?  I am quite worried that it might not be working.  They have done all sorts of tests to see if there was blood leaking anywhere and these all came back negative.  This is so frustrating that I still feel lowsey when the doctor said I would instantaneously feel better.  RJ

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