Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
Tags: low | iron | levels | anemia | injectible | iron

I Need Help for Low Iron

Thursday, 03 May 2012 04:59 PM

Question: I have been diagnosed with low iron and anemia. My doctor wants to give me a series of three shots of iron and then I will be tested again. What is the cause of low iron?

Dr. Hibberd's answer:
Anemia occurs when your blood doesn't have enough red blood cells. This could result if your body doesn't make enough red blood cells, if bleeding causes you to lose red blood cells more quickly than they can be replaced, or if your body destroys red blood cells.
Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color and enables red blood cells to carry oxygen from your lungs to all parts of your body, and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled. Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate, and other nutrients from the foods you eat. If these are missing, you will be diagnosed with a form of anemia. Folic acid deficiency anemia is treated with folic acid supplements. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.
The question really is WHY are you suddenly found to be iron deficient. You must find out why you are iron deficient, and if your doctor is not sure, ask for a specialty consultation/referral for further evaluation and SPECIFIC management. I am NOT in favor of random injectable iron management. It can be dangerous and there are much safer ways to solve this problem.
Iron deficiency most often is a dietary intake deficiency or a blood loss ( ie either premature breakdown or loss from bleeding) issue; and very, very rarely an absorptive problem related to a diseased , damaged or missing small bowel iron absorptive area.
Most important here is not to overlook a lesion of stomach or intestine (large or small) that may be bleeding, either from an infection, inflammatory state or invasion from another disease process such as malignancy or cancer. Is there any evidence of blood loss from other areas of your body (sinuses, nose, throat, urine, uterine, vaginal) or suggestion of inadequate production (bone marrow failure) or of increased destruction (heart valve, hemolysis from infection, immune attack or red cell premature destruction, etc.)?
Remember that blood loss from other areas of your body other than bowel will also cause an iron deficiency anemia, as your body will rapidly use up iron stores trying to make new red blood cells to replace those being destroyed or lost. Have you had heavy menstrual periods? Do you have nose bleeds? Is your health otherwise good?
Be sure your doctor has checked your urine for blood and also checked your stool (feces) for blood using a hemoccult slide on three separate occasions. If any doubt exists as to the presence of GI blood loss , a specialty referral to a surgeon or gastroenterologist for lower and or upper GI endscopy to visualize the bowel surface and exclude a colitis or malignancy is imperative.
Most physicians AVOID using injectable iron, not only because of significant expense, but also some patients have very serious problems with injectible iron formulations that can be easily avoided by using much safer and very inexpensive, three times daily oral ferrous sulphate 324 mg tablets by mouth instead of subjecting patients to higher risk and more expensive injectable preparations.
I am NOT a fan of injectable iron use unless you have totally lost the absorptive surface of your small bowel where iron is absorbed AND you have failed a trial of oral iron therapy.
A trial of oral iron would be more acceptable to most patients with iron deficiency, and most physicians would prefer to check your reticulocyte count after 7-10 days of oral iron to assess your response to treatment instead of subjecting you to the risks of injectable iron. Above all, find out WHY YOU ARE IRON DEFICIENT and correct it.

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Injectible iron should be a last resort after trying oral iron tablets.
Thursday, 03 May 2012 04:59 PM
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