another iron infusion? and low ALT level

[daisydaisy26]

Hello, dear RLS friends! I would really appreciate your advice regarding my mother's ferritin levels. So she is currently on 0.375 mg (some days up to 0.5 mg) and 900 mg neurontin. I know DAs are not optimal, but at this point it would really be a problem to withdraw, especially that mom did start with neurontin and at a higher dose and it didn't help her. So she had one iron infusion a year ago, which was very effective. But recently she is starting to complain again, I am thinking it may be time for another one, please have a look at her blood levels and give some advice if you can:

levels before iron infusion: iron 13.55 µmol/g, latent iron binding capacity 44 µmol/g, total iron binding capacity 57.6 µmol/g, transferrin 2.76 g/L, transferrin saturation percentage 19.5 %, ferritin 96 µg

levels after iron infusion: iron 19.57 µmol/g, latent iron binding capacity 32 µmol/g, total iron binding capacity 51.6 µmol/g, transferrin 2.53 g/L, transferrin saturation percentage 30.8 %, ferritin 324 µg

levels now (a year after infusion): iron 12.8 µmol/g, latent iron binding capacity 37 µmol/g, total iron binding capacity 49.8 µmol/g, transferrin 2.53 g/L, transferrin saturation percentage 20.1 %, ferritin 142 µg

so my concern is whether it's acceptable to have an iron infusion at this quite normal ferritin level? I remember from some guidelines that this transferrin saturation percentage value must be 20% minimum.

and just another quick comment - mom's ALT level (liver ferment) is <6 - she never had it so low. Even though it is considered normal to have low values (high values are usually a concern), I read that low ALT levels may be caused by taking levodopa (she is not taking it, but DAs are sort of the same type, are they?) and anti-seizure drugs (which I believe neurontin is), plus it may be a sign of B6 vitamin deficiency, which also causes neuropathy. I will try to ask our neurologist about it, of course, but maybe somebody can add an input. Thanks again to every one here - you really help a lot!

[SueJohnson]

Yes I would try to get another iron infusion for her as it helped and many experts think ferritin needs to be 200 to 300 and as you noted she is close to the below 20% TSAT where an infusion is definitely needed.

[Joolsg]

Yes, she should try for another infusion.Also, neurontin won't help if she's still on.a dopamine agonist. The severe, drug induced worsening(augmentation) just overrides neurontin.

The advice remains the same. She'll never be free of RLS unless and until she gets off that 0.375/0.5 of Pramipexole. Yes it's tough. If she couldn't make it before, she should try again, with the help of a low dose opioid.

A few people on here have managed it with minimal withdrawals by using Buprenorphine. So ask if her specialist will prescribe it to get her off Pramipexole.

I can't comment on the low ALT, but it could be linked to meds.

Mine is currently alarmingly sky high because of the chemo drugs I have been taking for my MS. I'm taking milk thistle and B6 to lower ALT and AST.