Hello

In April last year, we discovered that my 15 year old daughter had a ferritin of 4. All other iron related investigations were normal. In June she began a high dose of ferrous sulphate (3x200mg, later reduced to 200mg a day). Her ferritin is now at 21. Our GP doesn't want her to carry on taking any tablets, but just a multivitamin with iron because he is concerned that she could get iron overload. We would like her to continue with treatment, because we realise that ferritin needs to be at least 50 before good energy levels are achieved. She still has considerable weakness/poor energy levels, although we are now wondering if this may be caused by other factors also. Any ideas/suggestions, is iron overload a problem in my daughters situation?

Many Thanks

Iron overload is an issue and it seems that GPs are EXTREMELY cautious about it.

I have never take large-dose iron even though my ferritin was 5. It was suggested to me, but I couldn't tolerate it. So, I went on my own therapy of taking two multi-vitamins per day. When my ferritin hit 20, my GP told me to "stop taking the horsepills now and switch to a multivtamin". (He didn't remember, I guess, that I wasn't taking the "horsepills.")

I think if you were going to a hematologist, they would probably tell you to continue with the high dose for awhile, but since GPs are not well-versed in this (and many wouldn't even flinch at a ferritin of 21), then this is what you've run into.

As long as you are having the ferritin monitored frequently, I'd probably stay on the higher dose iron (maybe once a day). If you are only checking it every six months you may just want to be careful.

Thankyou for your reply. We spoke to our GP again today about the iron overload. He said that my daughter's iron saturation level is 43% and that if it reaches 45 she will have iron overload, which could create problems like liver damage. He won't prescribe any more iron and recommends that she takes a multivitamin every other day. We really don't want other complications, or to go against our doctor, but we are so concerned about her ferritin and that it will drop, and she won't get better. Are there any iron supplements that don't effect iron saturation levels? Also, since all of her other iron related tests are normal, is it worth asking for inverstigations into why her ferritin is so low? We never really knew why her ferritin was low, we could only associate it with heavy periods. Thanks

All the iron is going to affect the body in the same way.

That her iron saturation is high is a good thing. Ferritin takes a LONG time to raise. It could be that by just taking a multi-vitamin, her ferritin will continue to slowly rise.

I agree that you should follow your doctor's instructions given the saturation percentage but make sure you follow up with the ferritin.

As for why she is 21, you know, this could just be her "normal" value. Not everyone is the same which why there is a HUGE range for the ferritin. I really wish they would start doing "baseline" ferritin measurements on people, when they feel good, so they know what is normal for each individual.