Anemia without low iron

We have just change doctors.  My 16 yr old daugher has been on iron tablets for 18 months for mild anemia.
This has resulted in her hemoglobin levels going down but the iron stores going up but still low.

She is now being tested for thalassemia (waiting test results).
We were told by other doctors that the anemia was due to amount of exercise.

Hemoglobin is now 106, could this result in fainting while exercising.

Are there other supplements that we help with raising hemoglobin levels.

There are numerous causes of anemia, iron deficiency just one, but it is the most common, that is why iron tablets are usually the first means a doctor will recommend to correct it; especially if the blood work shows the red cells to be microcytic (low mean corpuscular volume aka MCV) and hypochromic (low mean corpuscular hemoglobin aka MCH)

The only type of anemia I’ve heard of caused directly by exercise is footstrike hemolysis, this happens when red blood cells in the feet are destroyed by the repeated impact of running, marching etc.

An Hb of 106 is considered mild anemia, but fainting during exercise with it is likely if the exercise is strenuous and accompanied by dehydration. The effects of mild anemia can also be exacerbated by many co-morbid conditions such as asthma

My daughter also has asthma and low blood pressure 85/40

Good to know the anemia is only mild

She enjoys competitive swimming and is currently doing 9 x 2 hr swimming session per week.  I was just wondering if this is too much exercise for someone with even with mild anemia.

Test result from 03/08/2011                    23/07/2010
Haemoglobin 106                                     114
Hct 0.32                                                 
RBC 4.1
MCV 78                                                   82
MCH 26                                                   26.7
MCHC 333                                               326

S Iron 3 L                                               
S TRF 2.3                                                2.6
S TRF. SAT 5                                           9
S Ferritin 30                                             16

Thalassemai screen has come back clear, but testing agency recommends retesting in 3 months.  But Sarah's doctor says he would bother as there is no history in the family and she is not in any of the risk groups.

He also says to continue with blood tablets and rich diet.  He is of the believe that the S Ferritin needs to increase to between 50-80 before the haemoglobin levels begin to increase.

Also gave as a referral for Full Blood Examination and Iron Studies, to be completed in 2 months after taking iron tables everyday.

Thank you any advice

Hi Catherine,

Vitamin C can be taken with iron to aid absorption. Her iron numbers look extremely low for someone who has taken iron for 18 months. I would talk to the doctor about trying a different form of iron, as it is often trial and error to find a form of iron that is easily absorbed.

Thanks will try taking Viamin C.  Due to her age, I not sure if she has been taking the iron everyday.
I have told Sarah, if levels do not improve will have cut some of the swimming sessions.  This should her remember to take the tablets.

Thanks for your advise.
Catherine

Is worth having my other two daugher iron levels test.  They have never had any blood tests.  They are aged 14 and 12.

Thank you your advice.
Catherine

If there is any sign of anemia in the others, such as tiredness or fatigue, get them checked. If not, there is no reason to bother.
With teens, it is often a matter of maintaining a good diet. Often meals are rushed and incomplete. Sarah may pay more attention to her diet and try to get more fruits and veggies if her activities are subject to how her health is. (I realize how hard this can be with teens. I have my own ongoing battle with my 16 year old son and his weak diet).

Thanks for advice Andy

No 2. daughter Rachel, is very small.  She does not like to excercise and would sit still all day if she could.
She isabo ut 2 cm taller than her 12 years old sister.

She has always been slow growing eg was born 10 lb 1 oz but fail to double her birth weight until she was 13 months old.

She is now 14 year old and has very few signs of pubertly

Is slow growth a sign of amenia?

Many thanks for your assistance

Catherine

Hi Catherine,

Anemia stunts the growth if the Hb is chronically low during development, as low oxygen levels do have a negative effect. With thalassemia, there are also bad red blood cells produced that are useless and die early, contributing to the anemia. In addition, there are unmatched alpha globin chains that bind together into tetramers, which cause oxidation throughout the body and can have a harmful effect on the pituitary gland. Rachel actually sounds like a symptomatic thal minor. I would recommend a hemoglobin electrophoresis test to see if a hemoglobin disorder like thal minor is present. Since both girls seem to be affected by anemia, this test will be very helpful in determining if it is a genetic trait or a nutrient absorption problem.

Thanks, will start with getting iron studies for Rachel done.

And request a copy of Sarah's negitive test which I was told by the doctor said to retest in 3 months.

Begin thank your assistance.

Catherine

HI,

I'AM ALSO TAKING IRON + VIT. C, BOTH OF THEM IMPROVED MY VERY LOW LEVELS OF IRON. MAYBE YOU MAY TRY COOKING(BAKING) FOOD LIKE LIVER AND SPLEEN TO YOUR GIRLS, I HAVE TAKEN TWICE A WEEK LIVER/SPLEEN, THIS TWO ORGANS HAVE A LOT OF RBC WHICH MEANS MORE IRON IT MUST HELP.

ANISA

Hi,

Even i have given goat liver and kidneys to my 5 yr old. It has increased iron to a great extent. though hb will take its own sweet time (in case of thal minors) before we know at what levels she will stabilize.

Take care
Kiya

Took Rachel to doctors to only to be told she is not short and just wait she will grow a little more.

Rachel is 5ft 2 1/2 (age 14 and 1/2) according to doctor is on 48th percentile for height.  After Rachel told the doctor she was short for her family we got a referral to paediatrician.

Father is 6ft 3
I'm 5 ft 5
Sister 16 is 5ft 9
Sister 12 is 5ft 2

Will make appointment another GP and one with paediatrician, and will hopefully be able to get blood test out of one of them.

The growth can be unpredictable but if she is sluggish with poor appetite, it's good to check for both anemia and vitamin D deficiency.

Thanks for all your help.

Have Sarah's Haemoglobin Electrophoresis results of 10/08/2011

B Haemoglobin A2  2.7% (1.8 - 3.5)
B Haemoglobin F <1.0% ( <1)

Comments:
Borderline red call indices with borderline ferritin level and mildly elevated inflammatory markers. Recommend trial of oral iron with review in 6 months.
If the red cell indices remain borderline, a repeat HBEPG with DNA analysis should be considered to exclude an alpha thalassaemia trait.

I gather the above rule out thalassaemia minor.

Regards

Catherine