Iron deficiency anaemia missed by GP?

[Newmummy82]

I was diagnosed with hashimotos last summer and am taking 75mcg of Levo.

I’m gluten free and have been supplementing with selenium, magnesium, b12 and bit d3 since the new year.

I recently suffered my first migraine in my life in the day my period started. This was accompanied by dizziness, weakness, and heavy legs. I felt like I did before starting the Levo so went to see the GP for a blood test.

Blood was taken at 8am having fasted and no Levo for 24 hours.

When I called for results was told everything normal and no further action needed.

As this site advises I asked for copies of my results, which are as follows,

TSH 1.2 ( they didn’t test T4 or T3)

However they did do a full blood count and vits and mins with the following results,

Ferretin - 36 (20-30 depleted stores) there’s even a note on from the lab saying ‘please investigate and correct it appropriate.’

This is also down from 64 in January when I had a Medichecks test done. (Although GP wouldn’t know that)

Red blood cell count - 4.63 ( 3.8 - 4.8)

Mean cell volume - 84.0 ( 83.0 - 101.0) so only 1 inside ref range.

Mean cell haemoglobin level - 27.4 ( 27.0 - 32.00) only 0.4 inside range.

Now I’m not a doctor but don’t these results point to me being iron deficient and anaemic?

My red blood cells are small ( although there are enough of them) and haemoglobin is low.

Im thinking of calling the surgery tomorrow to speak to the GP about iron tablets etc but wanted to check that I’m not getting it wrong!

The more I think about it the madder I am, especially as there is a note from the lab next to ferretin and the low iron would explain a lot of the symptoms I have!

[SeasideSusie Remembering]

Now I’m not a doctor but don’t these results point to me being iron deficient and anaemic?

Officially no. They're in range which is what most doctors see, they don't appear to have any concept of where in range being important. If they are in range the doctor doesn't have to do anything. Some doctors will, others wont.

You ferritin is not in the "depleted stores" category. The note that says ‘please investigate and correct it appropriate.’ would be a generic comment and may only apply to the depleted stores category.

Your ferritin is low, I imagine the range may go up to 150ish, and you would feel better if you were higher in range, but your GP just sees it as in range so he hasn't got to do anything. I was actually offered iron tablets when my ferritin was 39 (15-300), I pointed out to the Advanced Nurse Practioner (so much better than the doctors at my surgery) that it was previously 119 (13-150) (although I didn't mention it was a private test) so it had fallen quite a bit, so he immediately offered a prescription. I actually thanked him and declined, saying I'd rather raise it by eating liver and he was happy with that.

You could point out your very low in range MCV and MCH levels and hope they're taken seriously, emphasise the fact that they have barely scraped into range. Good luck, let us know how it goes.

[Newmummy82 in reply to SeasideSusie]

Thank you! I’m very up and down at the moment, some days feel good and others I’m exhausted! I will keep you posted.

[Newmummy82 in reply to SeasideSusie]

I’ve just checked and yes the range for ferretin is up to 150 so I’m at the very low end of ‘normal’

[SeasideSusie Remembering in reply to Newmummy82]

So as 20-30 is mentioned as depleted stores, say the range goes from 20-150* then with a level of 39 you are 15% through the range. If the range is the same as Medichecks - 13-150** - then you are 19% through that range.

You could mention to your GP that you are 15% through range (or 19%), and that if you had a higher ferritin level of, say, 130, then you would be either 85%* through range or 86%** through range. Ask how you can possibly feel as well with a level 15% (or 19%) as you would with a level of 85 or 86% through range.

If nothing else hopefully you've baffled him with figures

[Newmummy82 in reply to SeasideSusie]

Haha! Yes worth a try!

[humanbean]

I suspect that because all your results are within range you will be told that you aren't anaemic, and treatment will be refused.

I was very low (under the range) in serum iron some years ago, but my ferritin just crept into the range, and my haemoglobin matched the bottom of the range, so I was classed as not anaemic and therefore "fine". My doctor, very reluctantly and with very bad grace, gave me a prescription for two months worth of iron pills, after I begged for ages. I found out, purely by accident, that I could buy exactly the same iron pills without prescription. After the prescribed ones ran out I bought my own. It took me nearly two years to get my ferritin up to mid-range.

Please note that I paid to have private blood tests regularly while I was treating myself. Having high levels of serum iron or high levels of ferritin is dangerous and poisonous.

This test is worth doing :

medichecks.com/iron-tests/i...

Other useful links and info on a discount :

medichecks.com/how-it-works

healthunlocked.com/thyroidu...

thyroiduk.org.uk/tuk/testin...

thyroiduk.org.uk/tuk/testin...

If you get such a test done you can post the results in a new post and ask for feedback.

The supplements I took were ferrous fumarate 210mg, 1 tablet 3 times a day. They can be bought in boxes of 84, which will last 28 days. I haven't bought them for ages now, but they used to cost about £5 a box from either Lloyds or Tesco Pharmacies. They are cheaper online (ebay is a good source), and brand doesn't matter.

waltonpharmacy.co.uk/images...

People on the forum have got equally good or better results by eating a maximum of 200g of liver once a week, rather than taking iron supplements.

For more info on supplementing iron yourself and other useful links :

healthunlocked.com/thyroidu...

[Newmummy82 in reply to humanbean]

Thank you for the info, that’s very useful to know. I think it’s a good idea to test myself regularly as I know too much iron can be very toxic.

I hate liver, tried it last night for first time since a child and I had to drench it in mustard. Other half threw his in bin!

Can I ask how many of the ferrous fumerate tablets you took in a day?

[Newmummy82 in reply to Newmummy82]

Also, how often did you test your own iron levels?

[humanbean in reply to Newmummy82]

I already knew I absorbed iron poorly (something that many people won't know about themselves), so I started testing roughly every 2 months to begin with. If you don't know your own reaction to iron then I would suggest testing every 4 - 6 weeks for a while.

After testing 2 or 3 times, and having found out that I absorbed iron even more slowly than I realised, I stretched the time that I went without testing by about a month to save a bit of cash. When I got closer to optimal I shortened the time again.

I now take a maintenance dose of iron to try and keep my ferritin within optimal range. (My serum iron never gets even close to mid-range, so I use ferritin to optimise my dose. I have seen some people for whom the opposite is true. I would suggest never going over optimal on any iron measures, even if that means some of them stay permanently low.)

I did once screw up when I was still trying to work out my maintenance dose and my ferritin went over range (not by much). I stopped supplementing altogether for four months and my ferritin dropped from about 170 to about 80 in that four months. (I wish I knew why it happened - I think it could explain a lot if I did.) People have to learn how their own bodies react to iron by experimentation, and caution is always essential when supplementing.

[Newmummy82 in reply to humanbean]

Thank you for the advice, I have a good diet and eat lots of red meat so suspect I absorb iron poorly but I will test regularly to check. Think I’m going to pick up some tablets from the pharmacy tomorrow and just by-pass the GP.