Iron Status

[kampingal]

Dr. Baraki,

My 17 year old daughter has severely restless legs, PCOS, anxiety and severe periods. (Diagnosed based on: testosterone, free - 5.7, SHBG - 10, DHEA - 352, testosterone total MS -26) After PCOS diagnosis she was put on birth control for mood and period pain and fluoxetine for anxiety. Her RLS continues to get worse and more disruptive especially in classroom when she is expected to sit still. In April 2021 her iron labs were normal and her Ferritin was 14. Her doctor suggested supplementation so we tried that. In July we tested again and her Ferritin has dropped and her other iron labs were out of normal. At that point the doc said to stop supplementing but had no further advice. Her PCP and OB say her labs are normal so have no other guidance either.

Do you think iron status could be an issue or is there any other direction you might suggest?

Kathy

[Austin Baraki]

Some of those lab findings are a bit unusual, but a ferritin of 10 in this situation would be highly concerning for absolute iron deficiency.

It is extremely surprising to me that the lower limit of "normal" on that lab is just 6 -- woefully inadequate. Should be at least 15, if not 30.

I recently did a podcast where I discussed the topic of Iron and iron deficiency, which may be helpful: https://sigmanutrition.com/episode465/

[kampingal]

Your podcast is one of the reasons I started thinking about this again. This definitely confused me at the time. Thank you for confirming that I'm not nuts! She's now old enough to go to our internal med doc and I've asked if she can re-test. Thank you!

[kampingal]

Hi Austin,

What kind of doctor would you suggest we work with to address iron status? Is this a PCP scenario? We are transitioning from pediatric care to general PCP. She's almost 18. I've attached last weeks updated bloodwork. Her Ferritin has gone up some. She's been to a hematologist about a year or 2 ago due to positive ANA with symptoms of fatigue, aches/pains, depression, hair falling out, weird but very random and interspersed painful rashes like tiny blisters on her fingers and toes, etc. He ran tons of tests for celiac and other things but he said everything was normal so not likely to return down that road.

This seems to be the overwhelming message we get. "Everything is normal. the end."

Thanks!

[Austin Baraki]

Hi Austin,

What kind of doctor would you suggest we work with to address iron status? Is this a PCP scenario? We are transitioning from pediatric care to general PCP. She's almost 18. I've attached last weeks updated bloodwork. Her Ferritin has gone up some. She's been to a hematologist about a year or 2 ago due to positive ANA with symptoms of fatigue, aches/pains, depression, hair falling out, weird but very random and interspersed painful rashes like tiny blisters on her fingers and toes, etc. He ran tons of tests for celiac and other things but he said everything was normal so not likely to return down that road.

This seems to be the overwhelming message we get. "Everything is normal. the end."

Thanks!

Her labs are textbook for iron deficiency. A low ferritin, a low transferrin saturation, and a high total iron binding capacity. Not normal, regardless of those lab reference ranges.

Primary care doctors should be comfortable with this, but not all of them are -- particularly with the use of IV iron in patients with more severe symptomatic iron deficiency, or for those who are not improving/resolving with oral therapy. In that case, referral to a hematologist would be the next step.