Labs help please? Feel like crap

So I know I am not alone in my problems with iron deficiency, but these labs have me a little scared. I had RNY 9/27/11. I have been following up with my surgeon and PCP who are both going to be fired because neither one of them is helping me with this stuff! I have been asking all along about iron deficiency anemia and both of them have pooh poohed me over my questions!!! I have been taking carbonyl iron from vitalady at 60mg and thought I might be okay. I wasn't even due for labs but what prompted me to have them done was a recent fatigue and poor exercise tolerance at the gym. I normally can run a 5k in 23 minutes and it literally took me 34 minutes dragging ass to complete today. Here are my labs from this morning...

Ferritin 5  (11-307)

Iron 24     (49-151)

TIBC 493 (161-497)

Transferrin 352 (180-382)

Hemoglobin 10.6 (12-16)

Hematocrit 33.3 (36-47)

MCV 77.3 (80-97)

MCH 24.5 (27-34)

WBC 2.6 (3.8-10)

What should I do? I feel like garbage and I have an appt with an internist but not until 3/11.

honestly i would call your surgeon.  your primary care dr still may not be concerned because your hemoglobin is 10.6.  i have to have iron infusions 1x/year.  you need to push the need for the infusions.

my ferretin drops to 8 and i am freaking out.  can't imagine what you feel like with ferritin with a 5.  i had to pitch a fit to get a referral to a hematologist this last time. the first time i had to drive 1 hour 30 minutes for 6 weeks to get iron infusions

Now my ferritin is around 65. Hemoglobin was normal

Tamara

I guess my suggestion would be to significantly increase your iron supplement between now and the appointment on the 11th (since, for whatever reason, the 60mg dose you are taking is not nearly enough).  How much to increase it, though... well, you have to decide that for yourself.  Since your appointment is only two weeks away, if it were me -- and this is only what I personally would do -- I would probably alternate the 60mg and 120mg (so you are taking a double dose 3 or 4 times a  week).    I don't think I would double it every day, but would want to increase it significantly so that the increased dose would be reflected in labwork they would do on the 11th.

I would also ask the internist about the possibility of iron infusion(s) in order to get it up more quickly.

Lora

I'm not saying how much the OP (or anyone else) should take, but what I personally would do is take at least 120 mg daily, maybe 180 mg, right now.  I would not expect to need to stay on 180 mg forever, but I would do that temporarily in order to try to bring those levels up.

Yeah, I understand.  Since I have never had iron issues (I just started taking an iron supplement, in fact, in the past year), I would personally stay on the conservative side of increasing it just because I don't know much about iron dosing, how quickly you respond, etc...  even for myself let alone for someone else.

If my levels were that low, though, I would be jumping all over my PCP or surgeon to see whomever I needed to see to get an infusion PDQ.

Lora

you are very lucky that you never had iron issues.  It is actually pretty amazing that you went this long without taking any iron.  I didnt start taking my iron until my 5 week post op visit and I was already iron deficient and my levels were great preop.  I also had my last period the day of my surgery, so  I have been post menopausal for the past 4 1/2 years and still need massive iron.  My NUT starts all post ops on 150mg of prescription iron - poly iron and I took that for 1 year until I switched to Carbonyl iron and went to 180mg and then to 240mg for 3 years when I stopped absorbing completely 1 day.  My ferritin went from 100 to 20 in 1 month.  That is when my hematologist started me on Iron infusions.  Due to so much inflamation - my ferritin levels are so hard to go by. So, after the first 8 weekly infusions, I now go monthly.

The weird thing - my ferritin in Dec right after my hernia surgery was 800 but my iron was 20.  They have to do a test called soluable transferrin receptor.  This is a test that is done on people with severe inflamation causing artificially elevated ferritin levels. After every surgery I have had over the past 4 years, my ferritin skyrockets like that - it is called a acute phase reactant

Yeah, I am not sure why some people have so much trouble and some people have very little.  You certainly have had a bad time with it. I actually put MYSELF on the iron because my levels had slowly dropped over the past 4 years worth of labs and if it dropped a similar amount again, I would be anemic by the time my next yearly labs come around.  I know that having had a hysterectomy back the the 90's contributes to the situation, but I am still only taking the iron supplement 3-4 days a week.

Lora

actually you are the rare one, almost everyone needs iron post op, even post menopausal woman and men.  I think you are the first person that I have heard of that has gone almost 4 or 5 years without "needing" iron desperately.  So many people are on high dose iron and iron infusions due to rediculously low ferritin levels.  Thank goodness my hematologist is more proactive and doesnt make patients wait until they are so low that they are falling on there faces with a ferritin of 5 or something like that in order to get an iron infusion.  When he saw me drop from 100 to 20 in 1 month, he automatically started me.   I cant imagine walking around like some of these women with levels so low.  Now I get my monthly maintainance and it is nice so I dont have to worry about taking any iron anymore.

The fact that you had a hysterectomy so many years ago is a big factor as to why you probably dont need as much iron as others, you probably had really good stores prior to surgery and you probably dont malabsorb it as much as others.

Smart move on starting to take your iron.  I didn't take it at all either until AFTER I become anemic.  I saw the trends which were going down slowly then the following year BAM I was definitely anemic.  I did have 2 surgeries that year and wonder if the additional surgery stress made the trend down go even faster.

I'm still very hit and miss on taking iron daily.  I just need to do it I know but (excuses, excuses) I drink a lot of coffee and know I need to wait 2 hours then promise myself I'll take it every night before bed and I just don't.

I would go see a hematologist to talk about iron infusions.

After that, I would increase my iron, a lot.  The ASMBS recommends 54 to 63 mg daily for women that menstruate, if their levels are good, but some people need much more than that.  Obviously 60 mg isn't close to enough for you.