Unhappy with lab results, could use some advice.

So I just finished my 1 year anniversary and had my labs done.  Most things look normal, my B12 is starting to rebound and is over 900 now, so that's good.  

But last year right before my surgery, my ferritin was a 119.  It has been going down steady even taking 120mgs of elemental iron a day.  It is now a 19.  My doc said that they don't start worrying until it's a 12, but I told her I was concerned about the consistent drop.  When I get the letter from her I'll see what they want me to do (right now I just have the online results).  If they don't want me to do anything, I think I should talk to my PCP to see someone.  I am tired a lot and I think that's why.  My iron levels did go up, but because the ferritin dropped, I think I should be concerned.

My protein also is going down, and I get about 120 grams a day.  It went from a 7.6 to a 6.5 (again a steady drop throughout the year).  

My calcium is at a 8.9 and my PTH level is a 25.9.  Do those seem normal?

i have to have iron infusions about once a year.  I finally got a referral to a hematologist close to the local big hospital.  Mine dropped from 126 when i had last iron infusion to 12.  I take my iron 2 hours away from my calcium an my antacid.

I did get concerned when mine went down to 12 but i will be honest my primary care physician and  the hematologist were not that concerned with my ferretin being a 12 because my hematocrit and my hemoglobin were still good.  the hematologist did go ahead and order the iron infusion.  I get dizzy when my ferretin gets too low.

I have been taking carbonyl iron since the beginning.  I wonder sometimes if i don't absorb that well.  This last time my doctor ordered a polysaccharide iron and i did better. 

What kind of iron are you taking??

Tamara

I take my iron at night, at least 2 hours away from anything else.  I take the tender iron with vit c, it's carbonyl.  

That is interesting about the dizziness, I get that too (passed out once in august).  I thought it had more to do with electrolytes, but it's not getting better really - I wonder if that could be my iron.  I have the results for my hematocrit and hemoglobin.  Do you know what the numbers should be for those?

my primary care physician and hematologist say that the iron level is not critical unless the hemoglobin are below 12 and hematocrit were below 37. Like i said the hardest thing for me was to convince the dr that i needed the infusion.  The first one the surgeon ordered and i had to drive a hour and a half 1 way for 6 weeks. The second time i refused to drive all that way.  We finally got surgeons office to call primary care physician and say that i needed the referral. 

Good luck with this.  I follow up with the hematologist in February.  This last iron was 1 iron infusion that lasted all day.

Tamara

Thank you.  My hemoglobin is 12.7 and hematocrit is 38, so it seems like they are on the border.  I am going to push for an infusion, I don't really want one but I don't want to feel this way anymore.  Plus, I know that my ferritin will go well below 12 if I don't do something about it.

My ferritin was 7 when I got an infusion.  That was 3 years ago and it has been dropping since, too.  It was 239 two years ago and on my last test in Sept. it was 151, up from 144 the year before.  I would like to see it higher but there isn't much I can do about it other then take the iron as directed.  My hemoglobin and hematocrit are both at both at the bottom of the range and my red count is low.  My other numbers are good, though.

I would ask your doctor for a referral to a hematologist if you are concerned.

You might want to see a hematologist.  My ferritin has dropped a lot too since my surgery.  I'm four years out and it's gone from something like 240 to 70, I think.  I don't have the numbers right in front of me and I'm too lazy to look it up right now.

You might want to try heme iron.  It's more expensive than carbonyl but might be absorbed better.  Unfortunately, iron issues are common in many RNY folks.

The protein drop is also pretty common, unfortunately,  I'm lucky I've been able to keep my protein level about 7.0 with about 90 grams a day.  How was your albumin and pre-albumin?

Your calcium and PTH are fine.  We like those on the low side.  When they get on the high side, it often means you're leaching calcium out of your bones, usually due to not getting enough vitamin D.