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My 12 year old daughter has been unusually tired for the past month or so. She goes to lie down in the middle of the day which she never did before, and finds it harder to get her work done. She repeatedly says, "I'm so tired." She's not a complainer and is usually a sporty, active girl. Nothing is out of the ordinary emotionally.

About two months ago she had a very bad virus that stayed with her for two weeks and then a subsequent ear infection which was treated with an antibiotic. A few weeks after that she had a short-lived intestinal virus. These things have gone through the family, with the rest of us getting scratchy throats or feeling queasy, but she's got hit hard.

She also began menstruating four months ago and has been having regular monthly periods since, but she says they last seven days and are equally heavy from start to finish.

I took her to our pediatrician because I was worried about the fatigue, and she was checked her for mono and thyroid problems, but those tests were normal. She also had a CBC and CMP. Her hemoglobin was about 13.2 but her ferritin was 18. My pediatrician wasn't concerned about the ferritin but I'm still wondering it that could be why she is so fatigued.

The only other things that came up flagged on her bloodwork were eos at 9, and low total cholesterol at 100 and high triglycerides at 105. I've read that low cholesterol and high triglyceride numbers can show up after illness, so I don't think I should be worried about those. If you think these require further investigation, though, please let me know.

I would appreciate any help in figuring out if there's something I can do to help my daughter. Thank you.

Hi, Kelli,

I would be concerned enough about the ferritin to make sure she is getting adequate iron.  She is not anemic, but her iron stores, based on low ferritin, are shot.  Why get the ferritin if one is not going to act on it?  She has iron deficiency, but not yet iron deficiency anemia.  Always be sure depression, even in a seemingly emotionally stable kid, is considered.

Check this out that I copied from another website:

Serum ferritin levels detect iron deficiency in the early stages; a low hemoglobin reflects a much later stage of iron deficiency. This is an important consideration, since with a normal hemoglobin and low ferritin levels the iron stores can be restocked by simply increasing the amount of iron in your diet. By the time the hemoglobin is low, iron supplements are usually needed. Symptoms of iron deficiency anemia, such as being tired, irritable, and having difficulty concentrating, may be present long before anemia is reflected by the hemoglobin tests. That is why a serum ferritin is an earlier and more sensitive indicator of iron deficiency.

Good luck, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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