Anaemia - what's severe?

[valleysangel92]

I've had problems with anaemia on and off since I was around 13 , at that age, I tried out a few different iron supplements and finally found just one that I was able to tolerate.

Since then I've tried others, and still only been able to tolerate one type (white sugar coated ferrous sulphate) . Earlier this year (around the end of August) I had borderline anaemia, and knowing my history my GP put me straight back on the iron tablets to avoid me developing more serious anaemia. However, this time my trusty fall back failed me, and made me feel very sick , my doctor told me to stop using them as it wasn't worth the side effects for such a small amount of anemia.
At the time, I was told to use otc supplements (again, made me feel awful) and was told iron infusions could be an option if those didn't work out.

In December, my GI asked for a new set of bloods in preparation for a clinic appointment (next Monday) . After the bloods had come back, I got a letter asking me to have a repeat test. My iron had come back as 6 (11-15 is normal).

In the UK, iron infusions are generally for severe anemia, but I don't know where the cut off point is.
I was wondering if anyone knows what is actually classified as severe? Or has experience with iron infusions? Since I have a history of not tolerating the tablets they may allow me to get the infusions anyway, but there are waiting lists which are longer for 'non-severe' cases.

 

[Catherine]

Low iron doesnot necessary mean anemia. Do you know what your hemoglobin level is?
Or your ferritin level?

First step repeat the test while fasting. My daughter lowest iron reading was 2 (5-30).

 

[valleysangel92]

I was told during the phone call that I was anemic but I don't know the level. By iron I mean ferritin, it's what my doctors automatically do and the repeat test was done without food ( I don't really eat breakfast and was feeling particularly rubbish that morning) .

 

[Catherine]

Ok the ferritin is low that means low iron stores but it is the hemoglobin level which tells you how severe the anemia is.

My understanding is the iron stores drop first followed by the hemoglobin levels.

Do you eat iron rich foods?

 

[valleysangel92]

My doctors seem to base the method of treatment more on how low the iron is rather than how low the haemoglobin is, especially in patients with a history of anaemia ( but they are a bit backwards with some things, so this could just be them. )

I don't eat a lot of green veg as it sets my crohns off, but I eat gluten free (I'm coeliac) and the vast majority of prescription gluten free food and a lot of shop bought food contains extra iron as its pretty common for coeliacs to suffer with low iron. So I'd say I get quite a high amount, I see a dietitian ones a year as part of my coeliac care team and they make a chart of what I am or aren't getting, and they always say iron intake is good.

 

[Catherine]

Have you heard of combination eating to increase iron absorption.

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Iron_explained
Dietary factors that boost iron absorption

Certain foods and drinks help your body to absorb greater amounts of iron:
Vitamin C (found in fruits and vegetables) increases iron absorption.
Animal protein boosts iron absorption from plant sources.
In most cases, cooking increases the amount of available non-haem iron in vegetables. For example, the body absorbs six per cent of the iron from raw broccoli, compared to 30 per cent from cooked broccoli.

Dietary factors that reduce iron absorption

Certain foods and drinks reduce your body’s ability to absorb iron, including:
Soy proteins can reduce absorption from plant sources.
Tannins from tea, coffee and wine reduce iron absorption by binding to the iron and carrying it out of the body.
The phytates and fibres in wholegrains such as bran can reduce the absorption of iron and other minerals.
Vitamin A helps to release stored iron, so not enough vitamin A in the diet could lead to iron deficiency.
Calcium and phosphorus reduce the absorption of plant-sourced iron.

 

[valleysangel92]

Yes I have heard of this, unfortunately most if not all of the veggies present a problem well cooked, so raw would be a night mare. I do however get a lot of iron and vitamins A-D through the coeliac diet, the prescription flour substitutes and bread are all fortified, and I use vitamin enriched drinks. I dont consume a large amount of calcium, but I do have high calcium levels, and unfortunately unless this peaks to an emergency level (3.0 i average around 2.8), there isnt much that can be done about it. My GI did try getting help from an endocrinologist, but the endocrine basically told me I wasn't his problem.

As a coeliac, wholegrains are a big no go for me, and I dont think i consume that much soy either, so the only thing out of that list that i really consume that much of is tea.

When I was younger, we did try me taking the tablets and drinking orange juice or eating a fresh orange, but found that it caused a problem with UTIs (ive been prone since I was a baby) so had to reduce those a fair bit.

In my bloods, the only vitamins or minerals that have ever come back out of range were calcium (high) and iron/ferritin (low)

thankyou for your input.

 

[emmaaaargh]

I had a haemoglobin of less than 8 (I say less than because I saw the results of a test done months before they recommended me for an infusion!) and a ferritin of 4 and got a Ferinject infusion after a month and a half. I don't know anyone else that had one over here but that's what I had

 

[johnsmclean]

I got two infusions of iron with a Hb value of 9.3 (UK).

With Crohn's issue is not just that anaemic but how to fix it. If gut inflamed you cannot absorb iron well so IV infusion best option ?

 

[ronroush7]

I don't know what is considered severe. I have had at least two iron infusions

 

[D Bergy]

It may not be just inflammation that prevents iron from being absorbed.

Part of our bodies defense mechanisms against pathogens is to prevent the uptake of iron into our body.

Most, but not all bacterium use iron to survive. When we are infected the liver releases hepcidin to prevent iron absorption, to starve out the bacterial infection.

While we cannot do without iron, I find it ironic that by supplementing we might be also feeding what is making us sick in the first place.

Dan

 

[johnsmclean]

It may not be just inflammation that prevents iron from being absorbed.

Part of our bodies defense mechanisms against pathogens is to prevent the uptake of iron into our body.

Most, but not all bacterium use iron to survive. When we are infected the liver releases hepcidin to prevent iron absorption, to starve out the bacterial infection.

While we cannot do without iron, I find it ironic that by supplementing we might be also feeding what is making us sick in the first place.

Dan

Very good point. Also, if on proton pump inhibitors that affects iron absorption.

 

[DEmberton]

I got two infusions of iron with a Hb value of 9.3 (UK).

With Crohn's issue is not just that anaemic but how to fix it. If gut inflamed you cannot absorb iron well so IV infusion best option ?

If it's serious enough they'll give you a blood transfusion. I was down to 8.5 at my pre-op assessment a week before surgery so the surgeon arranged for me to have two units of blood. It took about 6 hours, but by the time I left the hospital I was already feeling great. I had a fun weekend of having the energy to do all the things I'd been too tired to do for the previous year, and then Monday surgery.