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Suggest Treatment For Low Ferritin Levels When Diagnosed With Iron Deficiency Anaemia

Posted on Tue, 13 Oct 2015

Question: Hello. I am 45 years old. Heavy menstruation. Diagnosed iron deficiency anaemia. Initially 2 years ago my Hb was 9.8 and ferritin level 4 . I have difficulty tolerating oral iron due to horrible side effects. My Hb 3 months ago was 13.4 which is quite an improvement and is Within normal limits. My ferritin level is still low at 18 and I still feel rubbish!! Tired and lethargic. At what level will my ferritin be when I should begin to feel better. I had expected with the elevation in my haemaglobin that I would feel some improvement.

Answered by Dr. Srilatha Myaka (41 minutes later)

Brief Answer:
Serum ferritin indicate iron stores in the body

Detailed Answer:
Hello dear,welcome to healthcare magic.I understand your concern.
In my opinion ferritin is a storage form of iron so there is no much association with clinical symptoms like tiredness.
I would like to explain you regarding the importance of ferritin and HB levels.
Serum ferritin is a storage form of iron so it will not take part in oxygen carrying and other metabolic functions.So serum ferritin level fluctuation is least likely to cause any symptoms in patient.
Adult female serum ferritin level is 30mcg per litre.And if levels fall below 15 then it is considered as depleted iron stores.
Since your level improved from 4 to 18 I feel you are doing very well with respect to iron treatment.
Whereas HB level correlate very well with symptomotology in many cases.
I suggest you to repeat your HB, serum ferritin level and red cell indices.
And also explain me little regarding your menstruation like :-
1)Since how many days you have heavy periods?
2)Any pain during menstruation?
3)Any ultrasound done?
Kindly provide me the information.
Looking forward to hear from you.
Best regards...Dr.Srilatha

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Srilatha Myaka (28 minutes later)

Many thanks. Menstruation has been particularly heavy past 5 years & generally lasts 7 days. I have a regular cycle. I experience lower back pain and a dragging feeling in lower abdomen. I take ponstan to easy the bleeding and this also helps. Smear was clear, had ultrasound - no fibroids just very prominent blood vessels. Can't take oral contraceptive and don't want a coil fitted. When getting blood checked should I ask for further tests such as thyroid function ? Or anything else

Answered by Dr. Srilatha Myaka (32 minutes later)

Brief Answer:
D&C might help in diagnosis

Detailed Answer:
Hello dear,thanks for the information.I understand your concern.
Iam happy to know that your ultrasound report is normal and bleeding is controlled with ponstan.
If you have any associated history of weight gain,constipation,hair loss etc then thyroid profile might be needed.
D&C is a procedure which helps in ruling out any endometrial abnormality.This is the first preferred method in those with heavy bleeding in premenopausal woman.It is both therapeutic and diagnostic.So it might help in diagnosis.
I appreciate your choice of not opting for oral contraception pills or hormonal IUCD at this age as they are associated with sideeffects.
So along with Hb,serum ferritin,RBC indices D&C can be done.
If all the parameters are normal mostly the excessive bleeding might be a normal premenstrual change which subside spontaneously on its own going into menopause.
Hope this satisfies your query.
Feel free to discuss furthur.
Best regards...Dr.Srilatha

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Above answer was peer-reviewed by : Dr. Raju A.T