Chronic Iron Deficiency Anaemia

[carpra]

I was diagnosed with Crohn's Disease back in 2009.

I have been having iron deficiency anaemia for the last 7 years, even with the change of medications from Methotrexate, Remicade and now Humira. With Humira, i am now largely symptom free from Crohn's Disease, but the Iron Deficiency Anaemia has not gone away. I am having to go visit A&E every two months with low HB(<55) and Iron. The blood transfusions or Iron infusions does help but i start to feel the systems with in a few weeks from the infusion.

I eat a balanced diet and started avoiding tannins which inhibit the iron absorption. I am also taking regular iron tablets, but it does not seems to help.

I have had surgeries of the small bowel, i reviewed with the gastro for malabsorption but he does not agree that this is a case of malabsorption as other minerals are being absorbed, at the same time iron is not.

A shot in the dark if anyone had similar situation and were able to find a treatment that works for them. Thanks for your help.

 

[Scipio]

I eat a balanced diet and started avoiding tannins which inhibit the iron absorption. I am also taking regular iron tablets, but it does not seems to help.

I have had surgeries of the small bowel, i reviewed with the gastro for malabsorption but he does not agree that this is a case of malabsorption as other minerals are being absorbed, at the same time iron is not.

There are things you can do to optimize the absorption of iron tablets. To begin with, nearly all the dietary iron absorption occurs in duodenum - the portion of the small bowel immediately after the stomach. For this reason you should not use the "enteric coated" type of pill, since they delay the release the iron from the tablet until it is well downstream from the duodenum - too late to get absorbed. Just use the cheap, uncoated kind of iron pills.

Also, iron absorption is enhanced in an acidic environment, so it's a good idea to take a vitamin C tablet along along with the iron pill to ensure at least a mild acid is present. This is especially true if you normally take antacids and/or PPIs to block stomach acid.

Finally, iron absorption is increased on an empty stomach. So when I battled Crohn's anemia I took uncoated pills along with vitamin C pills about 30 minutes before breakfast in the morning. And it seemed to help. Unfortunately, both empty stomach and uncoated pills will also increase the risk that the iron pills will cause stomach upset/nausea. I usually knock the nausea down by eating a little yogurt after a half hour or so.

But having said all that, I'm surprised that you are still getting anemic after transfusions and iron infusions. Those are usually much more effective than pills at improving the iron status, so adding pills may help but still may not be enough. Are you actively bleeding somewhere? Did your small bowel surgery remove a length of duodenum? I can't help but wonder where all that iron is going.

 

[carpra]

There are things you can do to optimize the absorption of iron tablets. To begin with, nearly all the dietary iron absorption occurs in duodenum - the portion of the small bowel immediately after the stomach. For this reason you should not use the "enteric coated" type of pill, since they delay the release the iron from the tablet until it is well downstream from the duodenum - too late to get absorbed. Just use the cheap, uncoated kind of iron pills.

Also, iron absorption is enhanced in an acidic environment, so it's a good idea to take a vitamin C tablet along along with the iron pill to ensure at least a mild acid is present. This is especially true if you normally take antacids and/or PPIs to block stomach acid.

Finally, iron absorption is increased on an empty stomach. So when I battled Crohn's anemia I took uncoated pills along with vitamin C pills about 30 minutes before breakfast in the morning. And it seemed to help. Unfortunately, both empty stomach and uncoated pills will also increase the risk that the iron pills will cause stomach upset/nausea. I usually knock the nausea down by eating a little yogurt after a half hour or so.

But having said all that, I'm surprised that you are still getting anemic after transfusions and iron infusions. Those are usually much more effective than pills at improving the iron status, so adding pills may help but still may not be enough. Are you actively bleeding somewhere? Did your small bowel surgery remove a length of duodenum? I can't help but wonder where all that iron is going.

Thanks for your help. I get stomach cramps with iron tablets, but haven't tried all the different types of iron formulations, I will definitely give it a try. The surgeries have not removed the duodenum, it is further down near the ileum, so the malabsorption of iron is ruled-out. I keep wondering like you said, where all the iron infused are going as i am not actively bleeding(as far as i can tell), and there is no sign of active crohn's inflammation anywhere. The Gastro and Haematologist have not found what's happening, so i am on Monofer infusions, which has fewer side-effects but it takes a weeks to get prescribed and infused.

 

[asadmom]

This brand makes iron supplements in the liquid form. There are a few variations that they sell.