Suggest treatment for iron deficiency anemia

Posted on Fri, 12 Jun 2015 in General Health
Question: Hi,
TIBC 168/serum ferritin 10/transferrin 120/saturation 6%/RBC2.79/HGB 8.9
Taking 270mg ferris sulfate for one month. Clearly anemic, but why. Do I need more iron? is ferris sulfate difficult to absorb. Would I benefit from IV iron. I've been careful with protein intake but its all from soy. If I were seeing you what would you do. Also, saturation is 6% of what? Thank you in advance. XXXXXXX female 65
Answered by Dr. Ivo Ditah 30 minutes later
Brief Answer:
This is diagnostic of iron deficiency anemia.

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry to hear about this diagnosis of anemia. I have reviewed your information fully and it is suggestive of iron deficiency induced anemia. This means that the levels of anemia in he body are low. Iron is central in the production of iron. 6% refers to the percentage or iron carried by these proteins. Generally we expect values greater than 20%. All this information points to the fact that you have a low iron in blood.

The possible causes are insufficient intake or excess loss. Given your age, the intestinal tract is the most likely reason for loss if insufficient intake is not the cause. If I were your doctor, I will make sure you have done you colonoscopy screening to make sure all is well in the intestines.

Ferrous sulfate is a good supplemental form of iron. We only use IV iron when oral fails. At this time, we do not have enough reasons to switch you to IV. I will recommend that you follow the treatment as prescribed and only seek further management strategies if this fails.

I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Ivo Ditah 26 hours later
Dr. Ivo The md following me wants me to wait for hematology consult.
I started iron and already feel remarkable better. Your diagnosis is reassuring.
The quick charts for diagnosis indicate that the TIBC should be elevated for a diagnosis of iron deficiency anemia. None of the suggested maladies on the chart indicate that all of the lab levels would be low. Comment?
TIBC measures a protein. Does it indicate that I have low protein levels generally or is it specific to one protein.
More importantly how much iron should I take? If I'm supposed to take 27mg of iron is that number wouldn't that depend on whether it is absorbable heme or the less bioavailable non-heme. I'm now afraid of taking too much iron. The heme consult is a month away.
Thank you, again. XXXXXXX
Answered by Dr. Ivo Ditah 1 hour later
Brief Answer:
Is it possible to upload the report?

Detailed Answer:
Hi and thanks for this follow up.

Before talking more on this, it would be helpful to get the full results uploaded if possible. This is because different laboratory may use different cut offs according to the procedures used. This way, I will make sure I am interpreting according to the method used.

TIBC: Total iron biding capacity: It tells us how much iron this protein can bind. If it can bind more(higher %, then it has little iron bound to it and vice versa.) High values are supportive of low iron levels in blood. It in no way suggests that you may be having low blood proteins.

Transferrin: This is the protein that transfers iron. Low saturation is suggestive of low iron and high saturations are suggestive of sufficient iron levels.

Ferritin: Measures the overall stores of iron in the system. If it is low, it suggest low levels of iron and high means you are not low on iron.

As you must have noticed, interpretation depends on what the normal values are. These vary from laboratory to laboratory. I will like to look at what the numbers for the laboratory are so that I can provide consistent interpretation to you on this.

The iron supplement is based on the individual properties of that iron. The dosage and prescription have already taken into account its bioavailability.

I hope to hear from you.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
Follow up: Dr. Ivo Ditah 44 hours later
Dr Ditah,
I wish I could upload; my printer isn't working.
The normal values are what you are referencing. My 6% should be at least 20%. All my levels are low according to this labs norm. Why is the TIBC low with saturation at only 6%. My liver function is good, kidney EGFR greater than 60.
Would the colon--blood loss or lack of absorption--account for the low iron binding capacity?
I really appreciate your your encouragement. XXXXXXX
The md has changed his mind about the hematology referral. ?
Answered by Dr. Ivo Ditah 2 hours later
Brief Answer:
Yes, blood loss can account for this!

Detailed Answer:
Hi and thanks for this follow up.

Low Iron can explain most of the findings. The most common causes are low absorption in the gut and chronic blood loss. For now, I will recommend you continue with supplementation and do a control in 4weeks. Depending on the results, more decisions would be made. Probably your doctor has not found strong justifications referring you to an Hematologist at this time and reason why he has it on hold.

In all, be calm. Continue with supplementation and we would evaluate in 4weeks to see response. Keep me updated about this. For uploading the results, you can take an image with your phone and upload. But not mandatory.

Until next, I wish you well.
Above answer was peer-reviewed by : Dr. Shanthi.E
Answered by
Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3922 Questions


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