long term anemia

[shellyB]

I have been anemic and have a very low ferritin for over one year. My ferritin is at a 2 but I am unsure what this means.I have been on ferrous sulfate 324 mgs twice daily with vitamin C for 2 years plus an additional multivitamin with iron. I feel weak, achy and am completely without energy. I am currently a member of a very large HMO with a team of doctors who disagree with one another regarding my case. One doctor has repeatedly told me he thinks I am bleeding internally but no follow up work has ever been done. How long should I wait before pursuing the source of the anemia? I am having a difficult time getting lab results other than a note that says, "still anemic, keep taking your iron". I will be changing HMO soon. A nurse inadvertantly told me 2 was dangerously low during a conversation on the phone. She called me back and told me she wanted to make sure I understood she wasn't giving me medical advice. Please help me understand how low and how long is considered dangerous regarding anemia. Are there any tests I should ask for or seek out independantly? Thank you very much for your insight.

[Kevin Pho, MD]

With a ferritin of 2, this suggests iron deficiency anemia.  The most common cause is blood loss, either obvious or occult.  The GI tract is the most common culprit, and unexplained iron deficiency requires a lower and (if necessary) upper endoscopy.

A less common cause of iron defiency would be difficulty in absorption.  Celiac sprue can cause this and should be ruled out - this can be done with a blood test.

I would certainly continue taking the iron supplements and discuss the tests mentioned 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.

[shellyB]

Thank you very much for your help. I have mentioned the tests you mentioned with my GP many times. I had an endoscopy that revealed nothing. A colonoscopy was done after after a horrendous night of PAINFUL bloody diarehea. It revealed many ulcers. I am currently on sulfasalzine for the ulcers. However, my biggest obstacle is that one of my doctors, a big wig in the HMO chain has diagnosed me with conversion disorder (somatoform) so now it is next to impossible for any of my physicians to take me seriously. All of my symptoms (complaints according to most of my drs.)never seem to be taken seriously but eventually have been proven true through labs and tests. They always have a reason or rationale why more testing should not be done. I have dysphagia so it is very hard for me to expand on my belief that something is seriously wrong. Prior to becoming ill I was an avid cyclist and had a zest for life and learning. I am barely a shell of what I once was and feel trapped with the dysphagia because my ability to comunicate is hindered at best. I have ataxia too. I used to be a professional bartender and waitress for 21 years, was a single mother of three, always babysat for extra money, and worked two jobs during the busy season in a tourist town. I considered myself very intelligent, well read and articulate with an incredible sense organizational skills. I used my skills daily given my profession. I now stutter and have a lisp, cannot concetrate, am always tired, cannot walk straight, have a great deal of physical pain and have difficulty with a single task, like using an ATM or remembering what I have just read or heard. This has weighed heavy on my self esteem. I am not looking to point fingers but for ANSWERS in the hope the old me may return. I forgot to add in my previous post that my neurologist was treating me for MS then decided I did not have it and stopped all medications. That was when he said I had somatoform disorder. I still have hope but it is fading fast. I will do my best!!!

[grizzly]

Having just come from iron infusion therapy, I can relate to the frustration. I am a 70 year old female who works full time of necessity (not choice). For the past 3 years I have had trouble with anemia, today's infusion was my 6th in that time period and 1 blood transfusion. My hemoglobin has been holding at 9.9 for the past 2 months, but ferritin has dropped from 168 to 11. I have had all the tests to eliminate loss of blood cause. I'm lucky in that I like what I do for a living, but it still puts quite a strain on my body considering my age and the blood thing. I really have not gotten any specific cause from my hematologist so next appt, 2 months from now, I'll do as nurses suggest and go in with a set of questions I would like answers to. Sometimes we don't speak up and say what we need to know until after the appointment is over.  Best of luck. Grizzly

[joanna11]

Hi, Shelly,
I just read a posting on the Med Help 'Blood' Forum:
'Some kinds of anemia (pernicious anemia) can result from hypothyroidism'

So, please get a paper copy of your Thyroid tests:
TSH
Free T3
Free T4
Thyroid Antibodies:  Thyroid peroxidase & Thyroglobulin
If the above tests are inconclusive, recommend:
TRH test (Kellman Center, 212-532-0600 is one of few labs that run this TRH test)

Let us know how it goes.  
joanna

[joanna11]

Hi Shelly,
I am not a medical professional, but I'm an anemic, caused by celiac and possibly hypothyroidism.  I would like to recommend that you ask for the blood tests for celiac/sprue, which can cause anemia:
1. Reticulin IgA Autoantibodies
2. Endomysial IgA Autoantibodies
3. Gliadin IgG Antibodies
4. Gliadin IgA AntiBodies

Please get a paper copy of your above tests, & a paper copy of your Anemia Panel (B12, Ferritin, Folate), and Thyroid Panel (TSH, Free T3, Free T4, Thyroid antibodies (Thyroid peroxidase, thyroglobulin), and TRH), and compare them to the ranges.

For Anemia: (liquid supplements are more easliy absorbed):
Floradix FloraVital Iron  + Herbs, Liquid Extract Formula, yeast-free & Gluten-free, alcohol-free, really helps.  Iron is absorbed best on empty stomach (upon arising 1 hour before eating, or later in day 3 hours after eating), at least 3-4 hours apart from antacids or dairy/calcium.  Take with a little orange juice for best absorbtion.  
Really helps.

How is your calcium number, on your blood test?  Did your bone scan indicate osteopenia?  You may want to try:
Floradix Calcium-Magnesium with Zinc, Vit-D & Herbs.  

Their tel# is 800-446-2110
URL:  http://www.florahealth.com

Let us know how things go for you.  
Keep seeking and you shall find.
Have a great day.

joanna