Dr. Mubashir Razzaq Khan
Hematology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My iron value is 16 (low), iron saturation is 4 % (alert low), my ferritin value is 5 ng/mL (low), my hemoglobin is 9.7 grams per deciliter (low), my hematocrit is 11.9 % (low), MCH 24.3 g/L (low), MCHC 30.4 g/L (low), EOS (eosinophil) 0.6 (high). My previous history includes anemia, possibly due to a vegetarian diet, a recent concussion, and a COVID infection. All other values are within the normal range. Unable to take more than 18 mg of Flinstone vitamin with iron orally.
Hello,
Welcome to icliniq.com.
I understand your concern.
Better take injectable iron preparations. With oral preparations, it takes years to correct iron deficiency, especially in females. It is best to build up your vitamin B12, folic acid, pyridoxine, and vitamin D level.
I hope you find it helpful.
Take care.
Patient's Query
Hi doctor,
She is having trouble getting scheduled for an iron infusion. It could still be two months away. Should she go to emergency? How critical are these low values? How does one get an appointment sooner?
Hello,
Welcome back to icliniq.com.
I understand your concern.
No need for emergency treatment. Hemoglobin is not critically low. Start a locally available oral preparation of iron, vitamin B12, folic acid, pyridoxine, vitamin D, and vitamin C. Take these preparations 20 minutes before a meal, once daily, preferably before breakfast. After meals, ingestion reduces absorbance.
Please upload a full CBC (complete blood count) report as well.
I hope you find it helpful.
Take care.
Patient's Query
Hi doctor,
She has been suffering from post-concussion symptoms for two months. She is progressively improving. Do you think the low iron stores may be inhibiting her recovery? She is extremely tired, cold, and a little short of breath. These are all symptoms of concussion as well. My medical history includes Amitriptyline 10 mg for headaches.
Cervical MRI bone marrow result shows mild diffuse loss of marrow fat signal, which can be seen in chronic anemia. I stopped Amitriptyline due to side effects; stiffness, sore legs, and difficulty walking. I took 325 mg of Ferrous sulfate for extreme vomiting and diarrhea and Flintstone vitamins with 18 mg of iron daily.
She did not have an MRI of the brain. However, H. Pylori and celiac disease were negative.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Yes, low iron stores slow down metabolism and recovery phases.
It is best to build her vitamin B12, vitamin D, and Co-enzyme Q10 (Ubiquinone) levels.
The rest of the management is fine. Continue with that.
I hope you find it helpful.
Take care.
Patient's Query
Hi doctor,
Should she take liver pill supplements? Is there a specific supplement you recommend without running the risk of toxicity? When she already takes the child's vitamins with 18 mg of iron.
Hello,
Welcome back to icliniq.com.
I understand your concern.
L-ornithine and L-aspartate syrup is good for liver health.
18 mg iron per day is too low. With this strength of medicine, it will take decades to recover from iron deficiency. Instead, I suggest 200 to 300 mg/day before meals, preferably before breakfast.
I hope you find it helpful.
Take care.
Patient's Query
Hi doctor,
Please reread the history and laboratory test results. She is unable to take iron orally (correction 5'9" height). I asked for other ways to get more iron since she cannot take oral iron preparations. My other question has been, Are the low iron stores due to the injury, medication, or vegetarian diet before injury and COVID? Is there a way to tell if she had chronic anemia before the injury? Does that MRI indicate that she already had anemia? Could that result have shown up just five months from the injury (she never had a brain image) or from Amitriptyline? I understand the treatment is iron (possibly iron infusion). What was the cause? I want to be sure that she is not having any autonomic dysfunction causing iron dysregulation.
Hello,
Welcome back to icliniq.com.
I understand your concern.
I went through history again. It is fine to take low-concentration oral preparations of iron if the infusion is ahead in a couple of months. After that, she should take iron infusions to correct iron deficiency. Because common oral iron preparations have only maintenance value, not corrective abilities.
Low iron stores are probably due to a vegan diet's low iron intake. Only a few vegetables have good iron content.
In general, women have low hemoglobin compared to men due to menstrual blood loss and poor intake of iron, vitamin B12, folic acid, pyridoxine, and other micronutrients. So, it could be said she has had anemia for years. The MRI (magnetic resonance imaging) cervical spine also indicates the same.
It seems longer than an injury. Iron deficiency develops after six months of reduced iron intake. This is because the body has stores of iron for six months.
Amitriptyline does cause iron deficiency in older people.
I hope you find it helpful.
Take care.
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Hematology
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