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03-06-2013, 05:35 AM   #1
upsetmom
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Low iron

My daughters iron is low at 110 and her ferritin is 13.
The GI was talking about iron tablets but then said we'll wait to see the next blood results. In the meantime he told her to eat lots of red meat. I think they were more concerned about the low ferritin level. What would cause it to drop its always been normal.
03-06-2013, 06:08 AM   #2
Catherine
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I think don't 110 is the iron level, I believe the hemoglobin level.

Iron range I have seen is 5-30 (umol/L)
Ferritin range is 30-200 (ng/mL)

Her body is using more iron than it can get from food maybr due to a slow bleed. Another possible is reason is that the ferritin has been acting as marker of inflammation and was never is normal range.

To understand it completely use would need a copy of the iron studies which should show,ferritin and 3 other numbers.
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DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)
03-06-2013, 06:12 AM   #3
Dexky
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Do you ever see blood in stools? If not has she had recent fecal cp test? If it's low, I don't understand why the GI wouldn't prescribe a supplement??
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03-06-2013, 06:13 AM   #4
upsetmom
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I think don't 110 is the iron level, I believe the hemoglobin level.
I think your right ..this is so confusing to me.
03-06-2013, 06:15 AM   #5
upsetmom
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Do you ever see blood in stools? If not has she had recent fecal cp test?
She doesn't bleed very often....and no shes never had fecal cp test. Its never been suggested.
03-06-2013, 06:20 AM   #6
Dexky
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Whenever my son would bleed and then stop, the fecal cp test has always been positive. He's had at least two. Both times corresponded to inflam markers on the rise though…so everything else was ok on the latest bloods??
03-06-2013, 06:28 AM   #7
upsetmom
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ESR & CRP were high and there were a few more things wrong but i can't remember.
03-06-2013, 06:35 AM   #8
Catherine
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The test Dexy is referring to is not covered by medicare.

My understanding is with low ferritin, the standard practice is to supplement with iron for 6 months are retest. (this is for a healthy person).

When is her next bood test and what have they ordered.
03-06-2013, 06:36 AM   #9
Dexky
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Can you buy otc iron supps? "Lots" of red meat could cause some problems with a chronie I'd think!?
03-06-2013, 06:40 AM   #10
Catherine
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Supplements for iron can available over the counter.
03-06-2013, 06:44 AM   #11
upsetmom
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She had a blood test today but the iron studies weren't included.

Would it be a good idea if i just went and bought some iron tablets and gave them to her.
03-06-2013, 06:55 AM   #12
Catherine
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You should have results by friday, if the hemoglobin drops i'm sure the doctor will suggest supplements. Ferro-grad is the normal one used for iron deficiency it becomes im three forms: iron, iron with ferritin and iron with vitamin c.

It is hard on the stomach, if this is a problem take with meal. It is also best to take with orange or pineapple juice.

If decide to start iron make sure you tell the doctor.
03-06-2013, 06:58 AM   #13
upsetmom
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Thanks Catherine i'm actually going to talk to the nurse tomorrow ....i ask her about iron supplements.
03-06-2013, 07:41 AM   #14
Bubbly
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Something my son has struggled with, iron levels, had supplements once for him but they can cause problems as not very gently on the tummy.

My son likes meat balls, or anything with mince really, easy to digest for him, also liquorice sweets, apricots, we tried to keep the iron levels normal with eating an iron rich diet, and fingers crossed so far it has worked.

Good luck x
03-06-2013, 09:06 AM   #15
Tesscorm
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I have problems with low iron, what I've tried...

- lots of cereals are high in iron - I've taken a small baggie of dry cereal with me to work to snack on during the day (I think Kelloggs Corn Flakes or Special K???)

- Some instant oatmeals have good amounts of iron, blackstrap molasses is high in iron (I've added a tsp of blackstrap molasses to my oatmeal - a bit sweet but not horrible).

- Just read on another post, dried prunes...

Try to take the iron with vitamin C - ie orange juice, berries, etc.
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03-06-2013, 01:19 PM   #16
CarolinAlaska
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From the American Academy of Pediatrics: Good sources of iron: many grains and cereals have added iron (check labels), egg yolks, red meat, potatoes (especially in the skins), tomatoes, black strap molasses, and raisins. Also to incease the iron in your family's diet, use the fruit pulp in juices.
From an UpToDate article entitled "Nutrient Deficiencies in Inflammatory Bowel Diseases":
Iron — Literature reviews suggest that 35 to 90 percent of adults with IBD are iron deficient [31]. Iron deficiency is probably the primary cause of the anemia that affects 16 percent of outpatients and up to 70 percent of inpatients [1,31]. Iron deficiency has a significant negative impact on quality of life and can lead to developmental and cognitive abnormalities in children and adolescents [32]. A study in adults with IBD and anemia demonstrated that oral iron supplementation increased hemoglobin concentration and improved quality of life without changing disease activity [33].

Other causes of anemia — Iron deficiency in IBD is usually caused by chronic blood loss. The resulting anemia is compounded by suppression of erythropoietin production and alteration of iron metabolism caused by proinflammatory cytokines, reactive oxygen metabolites, and nitric oxide, a condition called the anemia of chronic inflammation (anemia of chronic disease) [34]. Other potential contributors to anemia in patients with IBD include vitamin B12 deficiency, folic acid deficiency, or drug-induced anemia (eg, in patients treated with sulfasalazine or thiopurines). (See "Anemia of chronic disease (anemia of chronic inflammation)".)

Assessment — Assessment of iron deficiency in patients with IBD is complicated by the fact that ferritin is an acute phase reactant. Because serum ferritin levels increase in the setting of inflammation, patients with active IBD or acute infection may have a "falsely" normal ferritin concentration. Thus, patients with anemia and active IBD may be iron deficient regardless of the serum ferritin levels. Some have suggested that for patients with active inflammatory disease, serum ferritin levels below 100 mcg/L should be considered abnormal [31]. In addition, serum ferritin may be falsely normal in a patient with hypoalbuminemia.

Supplementation — There are two main issues related to iron supplementation in patients with IBD:

■Oral iron supplementation can potentially worsen symptoms and/or IBD activity. The available data suggest that many patients (approximately 75 percent) tolerate oral supplementation without worsening of disease activity, but some develop gastrointestinal side effects, a subset of which may be attributable to worsening IBD disease activity [33,35-37]. There are no established predictors of tolerance.
■Iron might increase oxidative stress and thereby contribute to carcinogenesis in IBD by augmenting oxidative damage and epithelial proliferation due to inflammation [38-44]. This is a theoretical concern, mainly from animal models. Whether these observations are clinically important in humans with IBD is unclear.

There are two general options to replete iron stores in patients with IBD: oral and parenteral (intramuscular, intravenous) supplementation. Oral formulations are much more convenient and less expensive and have, thus, generally been preferred as a first-line option. Indications for parenteral supplementation in adults include severe anemia (hemoglobin less than 10 grams per dL), intolerance, or inappropriate response to oral iron (a response is considered appropriate if the hemoglobin concentration increases by at least 2 g/dL or reaches normal within four weeks of treatment), severe intestinal disease activity, concomitant therapy with an erythropoietic agent, or patient preference [45]. The dosing and administration are discussed separately. (See "Treatment of anemia due to iron deficiency" and "Iron requirements and iron deficiency in adolescents".)

Tolerance to oral iron therapy varies substantially among patients with IBD. Those with mild intolerance (eg, mild nausea, bloating, diarrhea, upper gastrointestinal complaints) thought to be due to the iron may still be able to take oral iron supplements by taking smaller doses. Several oral formulations are available, some of which may be better tolerated than others. However, differences in tolerability may in part be due to variations in their iron content (with better tolerability in preparations containing less iron). Thus, whether one or another formulation has an optimal efficacy/safety profile is unclear since there have been no direct comparisons in patients with IBD. (See "Treatment of anemia due to iron deficiency", section on 'Side effects'.)

Among the parenteral formulations, intravenous iron sucrose has been most extensively studied in IBD and appears to be well-tolerated, effective, and safer than iron dextran [35,36,46,47]. A multicenter randomized, controlled trial showed that intravenous iron sucrose treatment is superior to oral iron in correcting hemoglobin and iron stores in IBD patients [48]. The main disadvantages of intravenous iron sucrose are its relatively higher cost, the need for parenteral administration, and the possibility of allergic reactions. Another disadvantage of intravenous iron sucrose is the dose limitation of 200 mg iron per infusion because anemic patients with IBD frequently have an iron deficit of 1000 mg or more. Thus, multiple infusions of iron sucrose are required. Ferric carboxymaltose (FCM) is an intravenous iron preparation that can be administered in single doses of up to 1000 mg iron within 15 minutes. Fixed dose FCM has been demonstrated to have better efficacy and compliance than individually calculated iron sucrose doses in patients with IBD and iron deficiency anemia [49]. (See "Treatment of anemia due to iron deficiency", section on 'Ferric carboxymaltose'.)

Although the available data are limited, we suggest the following approach to iron supplementation in patients with IBD and evidence of iron deficiency:


■In patients with mild to moderate IBD disease activity who have no known sensitivity to oral iron, we suggest supplementation with oral iron. Specific suggestions for initial treatment are presented elsewhere. (See "Treatment of anemia due to iron deficiency", section on 'Choice of preparation' and "Treatment of anemia due to iron deficiency", section on 'Expected response'.)
■In patients with severe IBD disease activity, we suggest intravenous FCM to avoid worsening gastrointestinal symptoms, since these patients are already particularly fragile. Other indications for parenteral iron supplementation in adults include severe anemia (hemoglobin less than 10 grams per dL), intolerance, or inappropriate response to oral iron (a response is considered appropriate if the hemoglobin concentration increases by at least 2 g/dL or reaches normal within four weeks of treatment), concomitant therapy with an erythropoietic agent, or patient preference. Intravenous ferric gluconate complex may be an acceptable alternative in centers where iron sucrose is unavailable, although its efficacy and safety in IBD have not been evaluated directly. Specific suggestions for the choice of agent and calculation of the dose of iron are presented elsewhere. Blood transfusion is generally reserved for patients with severe anemia or hemodynamic instability. (See "Treatment of anemia due to iron deficiency", section on 'Parenteral iron therapy' and "Treatment of anemia due to iron deficiency", section on 'Blood transfusion'.)
■Children and adolescents with iron deficiency anemia are managed similarly to adults, although the clinical indications for instituting parenteral treatment or transfusion vary. (See "Iron requirements and iron deficiency in adolescents" and "Indications for red blood cell transfusion in infants and children" and "Iron deficiency in infants and young children: Treatment", section on 'Oral iron therapy'.)
■Options for patients who have previously been intolerant to oral iron therapy include parenteral iron preparations, a trial with an alternative oral agent, or a gradual increase in the dose of iron (which can be accomplished by using a liquid formulation of iron sulfate). Administration with food may improve tolerability, albeit while also reducing absorption. (See "Treatment of anemia due to iron deficiency", section on 'General principles' and "Treatment of anemia due to iron deficiency", section on 'Side effects'.)
■Failure of the anemia to respond to treatment with oral or parenteral iron may indicate either an erroneous diagnosis of iron deficiency or the presence of a component of the anemia of chronic disease (anemia of chronic inflammation). In such cases, addition of erythropoietin to the treatment program may result in improvement of the anemia [50,51]. (See "Anemia of chronic disease (anemia of chronic inflammation)".)
I found these articles helpful. I hope they help you too.
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Osteoporosis/osteopenia, Scoliosis, EDS, Asthma, Epilepsy, Hla B-27 positive, gluten intolerant, thrombophlebitis, c.diff, depression, anxiety, postural tachycardia/POTS and multiple food allergies.
03-06-2013, 08:00 PM   #17
Dexky
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I thought this interesting…

Thus, patients with anemia and active IBD may be iron deficient regardless of the serum ferritin levels. Some have suggested that for patients with active inflammatory disease, serum ferritin levels below 100 mcg/L should be considered abnormal

and this almost amusing…

Literature reviews suggest that 35 to 90 percent of adults with IBD are iron deficient

Wouldn't want to go out on a limb and narrow it down a little would they!
03-06-2013, 08:51 PM   #18
CarolinAlaska
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Depends on the literature reviewed I suppose!
03-06-2013, 09:36 PM   #19
xmdmom
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It is true that ferritin can be increased with inflammation even when iron stores are low.

Hemoglobin can be decreased in IBD for a few reasons 1)iron deficiency 2)b12 deficiency 3) blood loss- microscopic or clearly evident 4) effects of "chronic illness"
5)drug induced

A paper "Guidelines on the Diagnosis and Management of Iron
Deficiency and Anemia in Inflammatory Bowel Diseases" 2007 gives
a ferritin <30 in healthy IBD, and ferritin <100 in active IBD as evidence of depleted iron stores.

Last edited by xmdmom; 03-06-2013 at 10:03 PM.
03-06-2013, 10:39 PM   #20
upsetmom
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I spoke to the nurse today...hameglobin is back up to 127.....no ferritin level it wasn't included in this blood test. Will get that done next week.
ESR & CRP are still climbing.

There's been no change in diet at all.
03-06-2013, 11:28 PM   #21
momoftwinboys
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Found the article with link below. Included some of the info below from the article. I heard milk makes it hard to absorb iron. A family member who is a pediatrician said she often found that anemic children were often big milk drinkers. H likes milk. We have made an effort not to serve milk as much, especially with iron rich meals. Do not know if it has made the difference but H's last two blood tests have been normal for iron rather than low. (knock wood)
Another thing we have tried is using an iron skillet for cooking more often.

http://www.nlm.nih.gov/medlineplus/e...cle/007134.htm

Iron deficiency anemia - children

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells bring oxygen to body tissues.

There are many types of anemia. Iron deficiency anemia is a decrease in the number of red blood cells in the blood due to a lack of iron.

This article focuses on iron deficiency anemia in children.
Causes

Iron deficiency anemia is the most common form of anemia. You get iron through certain foods, and your body also reuses iron from old red blood cells.

Iron deficiency (too little iron) may be caused by:

An iron-poor diet (this is the most common cause)
Body not being able to absorb iron very well, even though you're eating enough iron
Long-term, slow blood loss -- usually through menstrual periods or bleeding in the digestive tract
Rapid growth (in the first year of life and in adolescence), when more iron is needed

Babies are born with iron stored in their bodies. Because they grow rapidly, infants and children need to absorb an average of 1 mg of iron per day.

Since children only absorb about 10% of the iron they eat, most children need to receive 8-10 mg of iron per day. Breastfed babies need less, because iron is absorbed 3 times better when it is in breast milk.

Cow's milk is a common cause of iron deficiency. It contains less iron than many other foods and also makes it more difficult for the body to absorb iron from other foods. Cow's milk also can cause the intestines to lose small amounts of blood.

The risk of developing iron deficiency anemia is increased in:

Infants younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula
Young children who drink a lot of cow's milk rather than eating foods that supply the body with more iron

Iron supplementation improves learning, memory, and cognitive test performance in adolescents who have low levels of iron. Iron supplementation also improves the performance of athletes with anemia and iron deficiency.
Possible Complications

Iron deficiency anemia can affect school performance. Low iron levels are an important cause of decreased attention span, reduced alertness, and learning difficulties, both in young children and adolescents.

Excess amounts of lead may be absorbed by people with iron deficiency.
Prevention

Diet is the most important way to prevent and treat iron deficiency.

Good sources of iron include:

Apricots
Kale and other greens
Oatmeal
Prunes
Raisins
Spinach
Tuna

Better sources of iron include:

Chicken and other meats
Dried beans and lentils
Eggs
Fish
Molasses
Peanut butter
Soybeans
Turkey

The best sources of iron include:

Baby formula with iron
Breast milk (the iron is very easily used by the child)
Infant cereals and other iron-fortified cereals
Liver
Prune juice
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03-07-2013, 07:33 AM   #22
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My son is low on iron too. Shrimp is a good iron source and spinach. I have been juicing apples and spinach for him. Red meat is hardest to digest. Bananas have iron as well.
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No gluten, red meat, corn, cow milk, or msg

Last edited by dawn89; 03-07-2013 at 08:14 AM.
03-07-2013, 07:45 AM   #23
xmdmom
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If your child's hemoglobin is also decreased, I do not believe that dietary sources are enough to replete iron stores and normalize hemoglobin. They help but are rarely enough, in my experience.
03-07-2013, 08:09 AM   #24
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Yes, the doctor said it was affecting the hemoglobin. We have prescription iron pills. What about an old fashion iron skillet??
03-07-2013, 08:24 AM   #25
xmdmom
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Again, it helps only some in my opinion. We use one.
03-07-2013, 08:27 AM   #26
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Wow, there is a lot of iron in cereal, even cheerios and we took most grains away because we tried SCDiet. No wonder!!!
03-07-2013, 02:16 PM   #27
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We have been trying to affect iron levels with diet too, although recently hemoglobin is low enough that doc ordered supplements again

Calcium decreases absorption, vitamin C increases, so I try to pair iron rich food with C rich foods- spaghetti with meat sauce (either turkey or beef) and spinach. Or tuna sandwich with Vit C enriched apple juice (OJ is too acidic). He eats a big bowl of Cherrios every morning (big on iron AND folic acid!) and I think Rice Krispies are fortified too- can you do Rice Krispies with SCD?

I love the idea of snacking on dry ceral throughout the day. I make my son "trail mix" with assorted dry cereal and fruit. Way better than the empty calories from most crackers.
03-07-2013, 02:27 PM   #28
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We aren't to do Cheerios on scd either, but I have to get some weight and iron in him. No grains are to starve the bad bacteria though. Gluten and sugar are the worst for feeding the bad guys. Rice cereals would be easiest on digestion, so great idea. I will buy organic because most store brands have that nasty BHT.
03-13-2013, 03:20 PM   #29
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Sorry I am so late to this. You have been given fab advice Mum.

With her inflammatory markers on the rise just be aware that you don't have to see blood for bleeding to be a contributing factor. It can be far more chronic and insidious than that. FOB (Faecal Occult Blood) tests will confirm if intestinal bleeding is an issue, if it is needed.

I know bloods have just been done. Good luck!

Dusty. xxx
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03-13-2013, 03:27 PM   #30
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My son was low in Iron while on Prednisone because he was prescribed a PPI (proton pump inhibitor) to protect his stomach while on Prednisone. It interfered with his ability to digest and absorb iron so they added iron pills twice a day. I would ask the dr., they wanted a certain type of iron at a certain time of day for a certain amount of time.

Also, we were told it can take months for the iron to build back up in the blood so my son's blood levels were not checked again for about 2 months.
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