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There's really only one way to become Iron Deficient-- blood loss,
No, malabsorption is another huge way. Your gut needs to absorb iron from your food, and some autoimmune conditions or just poor diet, medications, and/or gut microbiome prevent people from absorbing iron. This is similar to why so many people are low in 'vitamin' D (and when they supplement, it barely budges their levels due to malabsorption). And if that's the case her taking iron supplements likely won't have a huge impact.
Malabsorption is probably the biggest reason people are low in iron, however GI bleeding is easier to diagnosis so it's more likely to be diagnosed. It's like the old joke about looking for lost keys - you begin to look where you have the most light, not where you more likely lost the keys.
Besides malabsorption, GI bleeding (which is also more likely caused by certain medications than CRC), illness can use up your iron stores as iron is vital in many immune pathways. A prolonged bout with COVID will deplete her ferritin levels. Also, heavy exercise will deplete your iron levels and unless your diet is good, you will become anemic.
No, malabsorption is another huge way. Your gut needs to absorb iron from your food, and some autoimmune conditions or just poor diet, medications, and/or gut microbiome prevent people from absorbing iron. This is similar to why so many people are low in 'vitamin' D (and when they supplement, it barely budges their levels due to malabsorption). And if that's the case her taking iron supplements likely won't have a huge impact.
Malabsorption is probably the biggest reason people are low in iron, however GI bleeding is easier to diagnosis so it's more likely to be diagnosed. It's like the old joke about looking for lost keys - you begin to look where you have the most light, not where you more likely lost the keys.
Besides malabsorption, GI bleeding (which is also more likely caused by certain medications than CRC), illness can use up your iron stores as iron is vital in many immune pathways. A prolonged bout with COVID will deplete her ferritin levels. Also, heavy exercise will deplete your iron levels and unless your diet is good, you will become anemic.
Very wrong again. Malabsorption is an uncommon route towards iron deficient anemia. Blood loss very common.
i've always been told my whole life that i have small veins.
i am 64 now, and the last few times i've gone for a blood draw, they haven't said this, and they've had no trouble finding a vein.
i always tell them ahead of time i have small veins, and this seems to help as maybe they are prepared or they want to show they are able to find it without multiple jabs.
I think phlebotomists are generally able to tell what you have in the way of veins when they palpate around your arms to find what's there. But it's not a bad idea to give them a heads up before hand, so they can be prepared.
Very wrong again. Malabsorption is an uncommon route towards iron deficient anemia. Blood loss very common.
It's very common, especially with all the drugs being prescribed.
Quote:
Iron deficiency anemia (IDA) not responding to oral iron replacement usually requires a hematologic evaluation. 48 patients taking a proton pump inhibitor (PPI) and not responding to oral iron replacement were found to have an elevated serum gastrin (SG). No patient had gastrointestinal bleeding, gastric resection, bariatric surgery, or menorrhagia. Other causes for iron malabsorption such as celiac disease or helicobacter infection were not present. 94 percent responded to intravenous iron (IV iron).
The medical literature you were instructed by is wrong and outdated.
I'm telling you from many years of clinical experience. Many more patients' iron deficiencies are prevented or cured by proton pump inhibitors, than develop it due to the PPI.
I'm telling you from many years of clinical experience. Many more patients' iron deficiencies are prevented or cured by proton pump inhibitors, than develop it due to the PPI.
The problem with relying on doctor's clinical experience is it's often more wrong than right.
The medical literature is littered with discarded medical interventions, practices, and Rx drugs that at one time had a cohort of Docs evangelizing their use.
If the patient has iron deficiency due to an ulcer, short term use of a PPI may resolve it, however they themselves block iron absorption in the gut.
Quote:
esults: Among cases, 2343 (3.0%) received a prior ≥2-year supply of PPIs and 1063 (1.4%) received H2RAs (without PPI use). Among controls, 3354 (0.9%) received a prior ≥2-year supply of PPIs and 2247 (0.6%) H2RAs. Both ≥2 years of PPIs (adjusted odds ratio, 2.49; 95% confidence interval, 2.35-2.64) and ≥2 years of H2RAs (odds ratio, 1.58; 95% CI, 1.46-1.71) were associated with an increased subsequent risk for iron deficiency. Among PPI users, the associations were stronger for higher daily doses (>1.5 vs <0.75 PPI pills/d; P value interaction = .004) and decreased after medication discontinuation (P-trend < .001). Some of the strongest associations were among persons taking >1.5 pills per day for at least 10 years (odds ratio, 4.27; 95% CI, 2.53-7.21). No similar strong associations were found for other commonly used prescription medications.
Also, not to offend Docs, but most Docs I see are not the paradigm of health themselves. We have a disease care system in this country (which ironically causes more diseases) not a health care system. Docs are trained to treat diseases, not optimize health so diseases are less likely.
The problem with relying on doctor's clinical experience is it's often more wrong than right.
The medical literature is littered with discarded medical interventions, practices, and Rx drugs that at one time had a cohort of Docs evangelizing their use.
If the patient has iron deficiency due to an ulcer, short term use of a PPI may resolve it, however they themselves block iron absorption in the gut.
Also, not to offend Docs, but most Docs I see are not the paradigm of health themselves. We have a disease care system in this country (which ironically causes more diseases) not a health care system. Docs are trained to treat diseases, not optimize health so diseases are less likely.
I have just a wee bit of long term clinical experience with PPI's. Starting back in the '70's as one of the first humans to be given an experimental precursor of omeprazole by my GI medical director. The introduction of histamine blockers, then PPI's both had huge positive medical implications. Symptomatic ulcers and reflux and then bleeds were much more common before then, and the enormous numbers of surgeries afforded crappy results. Through the years I've prescribed countless numbers of PPI Rx's. And can hardly recall any of those developing iron deficiency unless they do bleed.
Very wrong again. Malabsorption is an uncommon route towards iron deficient anemia. Blood loss very common.
I've always understood that B12 and folate deficiencies, and the anemia associated with these. deficiencies is more likely to be due to malabsorption than an iron deficiency would be. Not that poor absorption, or poor dietary intake of iron doesn't exist, but since iron is also recycled physiologically from breakdown of red blood cells and other cells, there is normally enough available to maintain the body's processes, and deficiencies become apparent during periods of increased iron demand, such as rapid growth in childhood, pregnancy, and ( drum roll.....) , blood loss during heavy menstrual periods, chronic bleeding from other sources. Or, as seen probably too often in third world countries or impoverished areas anywhere, iron deficiency anemias due to blood loss from heavy intestinal parasitic ( ie, hookworm) infestations, particularly in children. Or so I learned.
The tests my PCP ordered to investigate my anemia last year included iron studies, also B12 and folate levels. The B12 and folate levels came back within normal ranges, but the iron studies showed severe iron deficiency. I'd think that normal B12 and folate levels ( mine were actually at the upper normal ranges, but I take an oral multivitamin with those vitamins in it) would rule out a malabsorption problem with iron.
I don't know why FIWhatzistooth insists on downplaying the role of GI bleeding in iron deficiency, especially in the elderly. Depending on the frailty of an individual older person, sure, it's possible poor diet, inability to eat much, heavy antacid use, or other factors can contribute to iron deficiency. But wouldn't B12 and/or folate levels be low as well as the iron? Seems to me that once the iron deficiency is established, the first step taken is finding a source of bleeding. I'm glad they didn't decide my iron deficiency must be due to something other than bleeding and let it go at that.
I have just a wee bit of long term clinical experience with PPI's. Starting back in the '70's as one of the first humans to be given an experimental precursor of omeprazole by my GI medical director. The introduction of histamine blockers, then PPI's both had huge positive medical implications. Symptomatic ulcers and reflux and then bleeds were much more common before then, and the enormous numbers of surgeries afforded crappy results. Through the years I've prescribed countless numbers of PPI Rx's. And can hardly recall any of those developing iron deficiency unless they do bleed.
You have fairly easy tests for blood loss, which you then assume is causing the anemia. You don't have any easy tests nor medical literature to guide you on deciding if they're absorbing iron. Basically all you can do is take stool samples and that's if you know their precise iron intake or you can guess based on certain electrolytes to see if they have general absorption problems, or you look to the literature and see if they have Celiac's disease.
When all the tool's you have is a hammer, everything begins to look like a nail.
You have fairly easy tests for blood loss, which you then assume is causing the anemia. You don't have any easy tests nor medical literature to guide you on deciding if they're absorbing iron. Basically all you can do is take stool samples and that's if you know their precise iron intake or you can guess based on certain electrolytes to see if they have general absorption problems, or you look to the literature and see if they have Celiac's disease.
When all the tool's you have is a hammer, everything begins to look like a nail.
Very often the bleeding is very slow and/or intermittent, and we don't pick it up so easily with stool samples. In medicine when we hear hooves we first think of horses, not zebras.
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