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Hematology/Decreasing Ferritin - Increasing Iron

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QUESTION: Dr. Kulkarni,

I am a 46 year old female, and I started having ferritin and iron level testing done about seven years ago due to hair loss and lack of re-growth.  My iron and ferritin levels were both very low - 15ug/dl & 10ng/ml, so I began taking supplements.  About a year later these levels were at 68 (iron) and 40 (ferritin). I stopped the supplements, because of side effects, but the iron level continued to increase. I also started eating lean red meat regularly, whereas previously I rarely ate red meat. Six years later, my iron has increased to 141 without supplementation. But, the ferritin has dropped to 14.  From the reading I've done, it isn't normal for ferritin to be low and iron to be on the high side of normal.  I talked to my doctor's office today and was told "don't worry about it".  Unfortunately my hair loss still continues as well.  I'm thinking I need to get a second opinion.  Other lab tests were in the normal range - iron saturation, total iron binding capacity, unsaturated iron bind capacity, hemoglobin, hematocrit, corpuscular volume, etc.  I am not peri-menopausal per the blood tests, but my menses are very light and not regular - not a significant loss of blood.  What are your thoughts? I appreciate your feedback. Thank you so much.

ANSWER: Michelle,
Your iron levels though 141, are not above normal. So there isnt anything abnormal about it. But low ferritin is a concern. It means sufficient amounts of iron isnt getting stored as ferritin. Right now I would recommend you to take iron supplements along with vit C supplements. Are you taking medicines for any condition daily? Any chronic conditions you have? Do you experience abdominal pain? Repeat those 2 tests and LFT,RFT/KFT after 2 months of taking supplements. I will guide you further later on.

Thanking you!

---------- FOLLOW-UP ----------

QUESTION: Hi. Yes, I take Toprol XL, Wellbutrin, Lamictal, Zyrtec and Prilosec. I know the Prilosec can be really nasty, and I really want to stop using it but can't figure out how.  I've been on this drug for almost 20 years.  Anyway, so as you can guess, I have GERD and allergies.  I have depression issues which are well controlled. Finally, I have Lipedema Stage 1-2.  I don't have Abdominal pain, but sometimes a cramping sensation.  This isn't anything too new; however, as I've had constipation issues for 30 years.

What dose do you suggest for iron supplements?  Is there a type or brand you like that causes less gastrointestinal issues? I've had severe constipation in the past with iron supplements.

Thank you so much for your assistance. I will be looking for a different doctor in the near future, but in the meantime I really appreciate your time and expertise.

Answer
Michelle,
The repeated use of prilosec is concerning. Omeprazole reduces gastric acidity and may impair coversion of dietary iron from ferric to ferrous ions. This could impair iron absorption. Thats why I suggested taking vit C along with iron supplements. Its obvious that your ferritin levels are low as insufficient dietary source is triggering conversion of ferritin back to iron. So the stored iron(ferritin) is depleting. No I wont suggest you any brand(I live in India, I cant prescribe drug brands available in your country). You can take OTC iron supplements. Or incase you are sure that you get constipation by taking iron supplements then taking iron through injection/parenterally is recommended. For that you will have to visit nearest healthcare provider.

Thanking you!

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Dr.Shrinidhi Kulkarni

Expertise

I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!

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Working as a Doctor in Primary Health care Centre.

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KIMS Banglore

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MBBS, Internship in Internal Medicine

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