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Help for 16 year old daughter - ferritin etc

She has very heavy periods which she started when she was 13 years old. GP isn't sure if she needs iron tablets or not. She has been started on folic acid 5mg once a day and is also taking 800iu cholecalciferol for vitamin D deficiency. Thank you for any help.

FERRITIN - 38 (30 - 400)

MCV - 80.2 (83 - 98)

MCHC - 376 (310 - 350)

HAEMOGLOBIN - 116 (115 - 150)

MCH - 28.2 (28 - 32)

IRON - 7.3 (6.0 - 26.0)


RED BLOOD CELL COUNT - 4.42 (3.80 - 5.80)

WHITE CELL COUNT - 7.13 (4.00 - 11.00)

HAEMATOCRIT - 0.40 (0.37 - 0.47)

PLATELET COUNT - 253 (150 - 400)

CALCIUM - 2.23 (2.20 - 2.60)

CALCIUM ADJUSTED - 2.21 (2.20 - 2.60)

FOLATE - 2.35 (2.50 - 19.50)

VITAMIN B12 - 228 (190 - 900)

VITAMIN D TOTAL (25 OH) - 44.7





2 Replies


GP isn't sure if she needs iron tablets or not

Oh for goodness sake, if he isn't capable of making that decision then he should consult with or send your daughter to see someone who is!

FERRITIN - 38 (30 - 400)

MCV - 80.2 (83 - 98)

MCHC - 376 (310 - 350)

HAEMOGLOBIN - 116 (115 - 150)

Iron deficiency anaemia - and if us non-medically trained people know that below range MCV and above range MCHC indicate that along with low ferritin and haemoglobin, then why doesn't her GP? Some serious discussion needed, preferably with a different GP.

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):


How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

Each iron tablet should be taken with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

She can also help raise her ferritin level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...


FOLATE - 2.35 (2.50 - 19.50)

VITAMIN B12 - 228 (190 - 900)

folic acid 5mg once a day

What about the low B12? Has this been mentioned? Check for signs of B12 deficiency here b12deficiency.info/signs-an... but bear in mind that taking folic acid can mask signs of B12 deficiency so she needs to think back.

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

So something needs to be done about the low B12. She may need checking for intrinsic factor antibodies, she may have Pernicious Anaemia, she may need B12 injections. You can post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc


VITAMIN D TOTAL (25 OH) - 44.7 taking 800iu cholecalciferol for vitamin D deficiency

That's not enough, but unfortunately GPs are only allowed to prescribe 800iu for that level. She needs 5000iu D3 daily for 3 months then retest. The Vit D Council recommends a level of 100-150nmol/L so when she's reached that then she'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. She can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

Her doctor wont know, because they are not taught nutrition, but there are important cofactors needed when taking D3


D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit best and as it's calming it's best taken in the evening, four hours away from thyroid meds


Check out the other cofactors too.

As mentioned in your other thread, the Hashi's will have had a hand in trashing nutrient levels and will be causing gut/absorption problems which need addressing. See SlowDragon's reply to this thread for information and advice healthunlocked.com/thyroidu...

Thyroid hormone can't work unless nutrient levels are optimal so the Hashi's and the absorption problems need addressing then the thyroid hormone has a chance.

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Thank you, her low B12 hasn't been mentioned and she has symptoms of B12 deficiency. Will go to the other forum now.

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