Why is my anemia not responding to iron supplementation?

Question

I have had anemia for a long time, and my docs have always just told me to take iron supplements. However, there has never been a significant increase in my hemaglobin/hemacrit levels; there have been slight increases, but nothing that is permanent. Additionally, my RBCs are slightly microcytic. I am religious about taking my iron supplements, and I take them with orange juice. I am concerned because I am tired, I have trouble concentrating, I have chest pain occasionally that is really bad when I take a deep breath, my skin is pale, when I get sick I have trouble fighting it off, I get dizzy often, I get cold easily, and basically I am just tired of being sick and tired. My doc is a tool and he doesn't listen to me, so I am seeing another doctor soon, but I am concerned because my son is also anemic, so I want to make sure I know what I have so that I can help him.

FYI -I have never had heavy periods, nor any abnormal bleeding from any other orifice. I am currently taking 550% of my daily recommended iron intake, and have been doing so for some time on the advice of both my ob/gyn and family doc, with very little increase in hemacrit/hemaglobin levels. I take the iron supplements recommended by my doctor, which are the easiest to digest; they are also uncoated for easier absorbtion. Oh, and I try to watch what I eat and make sure I am getting good dietary sources of iron, too.
The story is pretty much the same with my son, who is 21 months old; he is not taking as much iron as I am, but he is on a liquid supplement as well as a regular daily vitamin with iron. I am also still breastfeeding him as his pediatrician recommended that the iron in breastmilk is more easily absorbed than other forms.

Oh, and the only ethnicity I have in my family other than Northern European is Native American, and possibly, some Portuguese.

Answer 1

Microcytic anemia is usually due to iron deficiency.

If you have been taking your iron tablets regularly have you been having heavy periods, bleeding from the back passage etc? Continuing bleeding may prevent your hemaglobin from rising.

Essentially, if you're Hb does not respond your doc should send you for further investigations to look for a non-obvious source of bleeding. Marked anemia can cause secondary cardiac chest pain but if this is the case you definitely need further investigation and treatment.

The other thing I would say is do you have mediterranean / arab / asian descent (even a long way back?). Occasionally microcytic anemia can be due to a genetic condition called beta thalassemia, more common in people from those regions. Although the well known form of the disease causes very extreme anemia, much milder forms which can be confused with iron deficiency can occur. If your son is also anemic then a genetic cause becomes slightly more likely.

Don't worry about B12 / Folate levels too much. Your doctor is bound to have checked them anyway and in any case they won't cause a microcytic anemia (they make the red blood cells bigger - macrocytic - instead).

Basically, if this has been going on a long time without an obvious cause (most commonly in women heavy periods) I would go back to your doctor, and if you need a second opinion, request it.

Good luck.

Answer 2

I suffer from iron-deficiency anemia, and while the folic acid in OJ allows the body to more readily absorb the iron, the vitamin C actually works against the absorption.

I finally just decided to take my iron pills twice a day. Once in the morning, once a night. I also eat some form of red meat at least once a week, and always give my body at least one hour to digest the iron pills before I eat or drink anything with a high volume of vitamin C. I found that helps tremendously.

Also, if you have heavy periods (like me) you may want to ask about going on the pill (unless you're still trying to have more kids right now). It really lightened up my periods (which also gave me more energy) and within a couple of months I was only borderline instead of "severely anemic".

Good luck!!

Answer 3

I agree with the previous answerer (ninja)- a microcytic anemia usually indicates an iron deficiency. If your son is anemic it does sound like you may have a familial (genetic) condition going on that is causing the anemia. Do you have any other relatives with problems with anemia? There are tests that can be performed to determine if this is the cause of the anemia. It is always best to try do determine the cause and treat that cause- and receive blood transfusions as a last resort. The benefit of a blood transfusion for the treatment of chronic anemia is temporary - and a few months later the problem is back.

Answer 4

I don't want to say too much, but it is definitely the right way to go to see another doctor for a second opinion. They will surely run some more tests on your blood to see what is up. The chest pains concern me alot though so I hope it is sooner rather than later that you get to the doctors.
It does take time for the HB to elevate..or rather, make a difference taking tablets alone..up to 2 months infact.

Answer 5

There is a type of anemia, called "pernicious anemia" which is caused by a vitamin deficiency.
Vitamin "B12".
Unfortunately it does not digest well and you may require vitamin B 12 shots.
However, you may be able to try a "sub-lingual" form which is absorbed under your tongue without an injection.
Try a Vitamin shop, before going to the Doc for injections...I hate shots!!!

Also you may need some folic acid...you can also get that at a vitamin shop.
RN, LNC

Answer 6

Iron tablets are notorious for not being absorbed very well. I would advise eating foods that contain iron and in a combination that helps absorbtion. Bran cereal comes to mind. Very high in iron and with a glass of OJ, should absorb very well. Has your doctor ordered a colonoscopy as a slow colon bleed will deplete you of iron and is not noticable enough to see in your poop so you would never notice it. I too have had that problem but my issues was heavy periods. I get the palpitations too. I am not a big beef eater and hate spinach so bran cereal was my thing. I got so constipated from the iron tablets that I just gave up on them completely. I eat bran cereal every morning and also as a bedtime snack. Cream of Wheat, shredded wheat and raisin bran are also good iron sources. You need the OJ(vitamin C) to help with absorbtion. Good luck.

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Answer 7

Are you taking Iron supplements that are easily absorbed by your body? Some manufacturers use minerals that are more like rock and others use minerals that grow in plants and are easier absorbed (like Spinach, etc.)

I use awesome Naturopathic Physicians and herbs from Nature's Sunshine because they really know what they are doing and I have seen first hand how great their quality control is. Here is a link to one of their Iron products:

http://www.mynsp.com/deamicis/products/guide.aspx?stockNum=1784

They also have kids products.

Peace!

Answer 8

I think you are doing the right thing to see another physician. The one you have now is a clown! You need a doctor that will listen...All the symptoms you are describing are anemia related. I suggest that if you feel weak, fatigued and are having chest pain..Go to your nearest Emergency room! Make sure you tell the ER doctor all symptoms..Then follow-up with a new Doctor..

Answer 9

I have anaemia, i take vitamin b12 shots every three months, you should go back to the doctor and ask about b12, if you levels dont improve over a few months, you could be bleeding internally, so further investigation maybe needed, goodluck, i hope u feel better soon.

Answer 10

First, I am in the -exact- same situation, so if you find a definate answer please contact me on yahoo on this name., Im getting desprate. Everyone I have asked said to just take prenatal pills and they will give me enough of the other supplaments that will help me hold in the iron *shrug* Just started a week ago , not sure if it works yet