Thank you!!

You got this!!

Increase your vitamin C intake. I had to double what I was already taking before we saw the iron pills have any effect.

😂 love it hahaha

This is actually something I struggle a bit with too! I think the way you practice can really vary. I know a lot of people try to avoid checking iron studies in hospitalized patients in the first place since they feel it would be inaccurate. But like you I do feel like it’s a great opportunity to detect IDA and get them started on treatment so I do actually like to test quite a bit. If you read UpToDate, they recommend treating if iron sat is low even if ferritin is elevated, as long as your clinical suspicion for IDA is high. Since I read that I’ve definitely been leaning more towards the side of treating for some of these borderline patients, and it’s a great opportunity in my opinion for outpatient PCP to recheck the iron levels in 4-6 weeks and also get endoscopy / other studies that might be necessary started earlier!

MCV

I learned that a low MCH and a low MCHC could also signal iron deficiency. I've had all of those at one point, a low MCH, MCHC, and MCV - along with target cells and rouleaux formation. My MCV is corrected by my MCH and MCHC are still low (hypochromic microcytic anemia).

Those situations are definitely a lot more tough! I'm not sure if there is any clear answer or evidence for it - but if suspicion is high and transferrin saturation is

@@ConanLiuMD Thank you for your explanation!

@@k.i.1700 He should have said that even when there’s no anemia the red cells show evidence of iron deficiency. The red cells will be smaller ( microcytosis) and less coloured ( hypochromic) If this is seen that’s strong indicator of iron deficiency without anemia

What is a "faring" level?

those may be "normal" levels but they're not optimal. maybe get a second opinion. i know you were not asking me but mine (30yo fem) are: TIBC 398, Serum Iron 60, Iron Saturation 15 and Ferritin 13.3. "Normal" but same as you, feeling really crappy in general. Had to get a second opinion and got supplements, but I'm only two days in and came across this video and the pills are enteric coated jajaj I just hope it helps me, if not back to the doctor I guess... good luck and I hope you get the help you need soon!

Hi Shavon, yeah that is a tough scenario and I don't really have a clear answer. I would probably see if your primary care doctor would want to trial oral iron supplementation for a few months to see if that helps correct the problem. The other thing to note is that if you aren't having any significant symptoms or anemia from the low iron saturation, we don't necessarily need to correct the number just because it's low on a lab test. Could be best just to check it / monitor regularly in that scenario rather than trying to aggressively treat it!

@@ConanLiuMD Thanks for your response, it's really appreciated. I am still having symptoms which include dizziness, tiredness, and dyspnea. I will speak with my hematologist about going the oral route with iron pills for a while to see if that helps, thanks for that suggestion. Hopefully, my ordeal will be situated sooner as opposed to later. Thanks again, and keep up the great videos! Have a good day!

That is definitely quite an experience you had! Sorry that it happened to you. From what you told me, that sounds like a very appropriate treatment course and I don't think it was too aggressive at all. Now that your ferritin is back up they should start pulling back on iron replacement to avoid iron overload, but it looks like it definitely did the trick and got your hemoglobin back up to a better level. Hope you are feeling a lot better!

@ConanLiuMD thank you so much for responding! Although, I did ask the doctors and nurses questions, I wasn't able to look up information myself. I tend to overthink and felt like I wasn't making an informed decision about my treatment. So, thanks for putting my mind at ease. They gave me a bunch of other vitamins as well, cut back on iron and will be monitoring my levels for the next few months. Take care and continued success in all you do!

I'm so sorry your daughter has suffered from such severe iron deficiency, and that truly sounds like a nightmare to deal with. I am curious, have they identified a cause for why her iron levels are so low? That would be the primary thing I would want to know in someone with such refractory iron deficiency. Regarding the elemental iron vs heme iron version, I actually don't know anything about it or if there is any literature on it. All the main studies done have been with elemental iron. Do you know if there is good evidence for using this heme iron? I am sometimes a little skeptical of "over the counter alternatives" to what we usually use, since sometimes they make broad claims that aren't backed up by literature (and they usually charge patients more in order to sell these products compared to normal supplements).

@@ConanLiuMD thank you for answering, and no we do not have a cause for the low iron. She has been through all GI tests including the pill cam, Rheumatology bloodwork, GYN had her on the pill to stop all blood loss for a while, she even had a tilt table test to determine if it was POTS causing the dizziness etc. All negative… very frustrating to not be able to treat the source of the issue.

A ferritin of 3? Have you ever looked into doing a parasite cleanse? I can almost guarantee this is a problem. Parasites eat our iron stores. A ferritin below 50, is most often Parasites. Check out Mrs. Kim Roger's parasite clease. Always start with making sure drainage pathways are open. Bowel movements preferably 2 times per day. She may need several rounds. Take a small break. Aprox 1 month. May need to Repeat to kill any eggs that have hatched. Good luck!!

​@@mmctaggart3012I use the Heme iron because it derived from meat. It also doesn't make my constipation worse and I have no stomach issues.

Honestly I think that sounds like really good reasoning to me! I also am still a little unclear about the exact utility of the Ganzoni equation, since most of the time I just give 1000mg regardless. I think your reasoning sounds pretty solid though but I don't know about the evidence either way regarding that. Thanks for bringing it up!

Many patients with Lupus will have anemia. Many patients with chronic gastritis will too (untreated or treated). Patients who use proton pump inhibitors/PPIs (the class Pantoprazole is in) and/or H2 antagonists (class that Famotidine is in) chronically sometimes have anemia (not everyone). If you're still menstruating, that can also contribute. Some females simply become deficient even with what we would think isn't a "heavy" flow. Regardless, it could be one, two, or all of them combined contributing. Your symptoms most likely are from the resulting anemia - whatever the cause - but you should still go talk to your doctor especially given the shortness of breath (could be something else). It'd be reasonable to start taking a ferrous sulfate tablet every other day too as it's low risk and you definitely would benefit from the labs. With your chronic gastritis, ferrous gluconate might be easier on your stomach or some other form of iron (but these can get more expensive). You can buy many forms of iron over the counter for relatively cheap. With what you having going on, diet might not be enough for you at this point.

pubmed.ncbi.nlm.nih.gov/31413088/#:~:text=In%20iron%2Ddepleted%20women%20without,is%20given%20on%20alternate%20days.

The most immediate ones that come to mind are 1) vegetarian or vegan diet (especially ones that exclude certain acceptable foods that are high in iron, like you avoid lentils, etc) 2) Heavy dairy consumption 3) If you eat tons of rice (certain kinds) 4) Celiac disease (gluten enteropathy) or other GI malabsorption diseases 5) Poor overall intake 6) Smoking 7) Heavy tea or coffee consumption If you're just getting small draw a month, I'd imagine most healthy individuals would be able to compensate for it. If they're taking quite a bit of blood, it wouldn't be a bad idea to grab a bottle of ferrous sulfate from the pharmacy and take it every other day for 2-3 weeks after each draw. You would have the benefit of hopefully being able to retest to see if that helps within 2-3 months.

@theblackout27 I stopped megadosing Turmeric and my iron levels are creeping up again. Thanks for your thoughts. Of the seven risk factors you listed only #1 applies to me.

I'm not a doctor, but yes you would benefit from it. 39 is low

You should definitely refer to your pediatrician for medical advice, but in an adult patient those numbers would not concern me at all!

Ferritin is pretty low. What is your hemoglobin? Are you female, and if so do you have heavy menstrual periods?

@@ConanLiuMD thanks for the reply! I'm a male. My immunoglubulin is 254.6 mg/dl. Ive consulted with a very expirienced hematolog and he wasn't concerned at all. He said that as long as the immunoglubulin is fine, then I shouldn't be worried. He also said that eating more red meat won't necessarily increase iron. He thinks I should take supplements as long as I feel good. Is that reasonable?

You are only borderline anemic but the ferritin is definitely quite on the low side, seems reasonable!

You need a parasite cleanse. I don't know why doctors don't tell people this. It's mind blowing. Parasites eat our iron stores. A ferritin below 50 usually always points to Parasites. Mrs Kim Roger's has a great cleanse.

Your labs seem okay to me but I wouldn't give any professional advice to you over the internet, would continue asking your own doctor! :)

@@ConanLiuMD but should I worry about my ferritin level

Have you ever heard of hemochromatosis? Could be a possibility with high iron as well as high ferritin... might give you a place to start.. good luck!

Possibly some mild iron overload, sounds like the infusions worked 👍

That's a little difficult to tell, how low is the ferritin? If extremely low I would lean towards iron deficiency.

You more than likely need a parasite cleanse. Parasites eat our iron stores. Low ferritin usually points to this. Mrs. Kim Roger's has a good cleanse