Your Easy Guide To Iron Deficiency

[@Brookv505]

Thank you so much! This video is the best video out there not only for med students but for the average person dealing with anemia! I learned a lot today. :)

[@Alice_Walker]

I am not a physician but this was a very clear explanation of the various tests and options. Thank you!

[@ConanLiuMD]

Thank you!!

[@bronzeriver3456]

Please do a medical check-up for gastroesophageal reflux disease (GERD) as your symptoms may be originating from a Hiatal Hernia and/or an H. pylori infection (this is the bacteria that causes stomach ulcers - I had to do an endoscopy with biopsy to confirm this as it did not show in my blood or stool even though it was in my stomach). You would be surprised how problems with your gastrointestinal tract affect your overall well-being. Symptoms may include unexplained weight loss and difficulty gaining weight, iron deficiency, anemia, dizziness, nausea, fatigue, loss of appetite, shortness of breath, sudden severe cold, palpitations (high pulse), high blood pressure or even slightly low blood pressure.

[@Veronica-tn2xc]

You're so right. I had h pylori and after months I still have anemia. It's so complicated.

[@sandraekhoff8937]

The best video that I have found so far!!,! Straight to the point. Thank you so much!!!

[@booboolou8505]

Thank you. Great video. The on screen text visuals also make it one of best iron videos I’ve seen so far.

[@arasantos1965]

thank you soooooo much! that was clear! ❤❤❤

[@thechancellor3715]

Thank you for clear explanation of blood iron test results.

[@mattlobo9188]

I agree. This is what I learned at UCSF as a nutrition intern! Great talk!

[@suzym5120]

My iron is 3 umol/L (16.7 ug/dL) and haemoglobin reached 127 and my haematologist isn’t concerned 🤦🏻‍♀️ Thank you!

[@finchwings]

Thank you for this! Thoughts on Heme iron?

[@carolyncobbs3207]

Was taking 324mg ferrous gluc for low iron. 2x/ day on MWF each week. Pulled back to 1x/day MWF in Feb ‘24 as iron levels were up to slightly elevated (169ug/dl, 58% saturation) but ferritin was elevated at 431. Then began 100mg micronized progesterone as a part of HRT regimen for menopause Mar ‘24. June ‘24 test showed iron level dropped to 28 to 1/6th of level before progesterone -with ferritin less but still elevated. Now on daily 324mg iron but experiencing loose stool-and concerned about ferritin. Have read that progesterone can adversely affect iron levels. Perhaps should try a different form of progesterone and go to every other day iron vs daily??

[@brendagsg9472]

What would cause TIBC low but everything else within normal range?

[@ltltornado3337]

thank you, this made me feel better as I wait several days to see a Dr hopefully within this month...my saturation is at a 5 and my Iron is 18 and ferritin 9

[@finchwings]

Current #’s: TIBC: 374 Iron Saturation: 29 Ferritin: 21 Dr. says my iron is fine. I don’t feel fine at all. Extreme fatigue, weakness and more. Currently on a protocol to rid h-pylori. Thoughts on my iron #’s? Based on my understanding am I correct in thinking I’m iron deficient? 🙏🏻 Thank you!!

[@JazzyChain24646]

those may be "normal" levels but they're not optimal. maybe get a second opinion. i know you were not asking me but mine (30yo fem) are: TIBC 398, Serum Iron 60, Iron Saturation 15 and Ferritin 13.3. "Normal" but same as you, feeling really crappy in general. Had to get a second opinion and got supplements, but I'm only two days in and came across this video and the pills are enteric coated jajaj I just hope it helps me, if not back to the doctor I guess... good luck and I hope you get the help you need soon!

[@psin4953]

Hello...I went to the ER for shortness of breath and found out I was severly anemic. My hemoglobin was 5.1 and ferritin 3. I was also beginning my menstruation (heavy with large fibroids). I was treated with 2 units of blood transfusion and 3 iron infusions before being discharged. My hemoglobin is now up to 11 and ferritin 340. Everything seems to be normal now, but I'm just wondering if the treatment was too aggressive? Thanks for the informative video!

[@ConanLiuMD]

That is definitely quite an experience you had! Sorry that it happened to you. From what you told me, that sounds like a very appropriate treatment course and I don't think it was too aggressive at all. Now that your ferritin is back up they should start pulling back on iron replacement to avoid iron overload, but it looks like it definitely did the trick and got your hemoglobin back up to a better level. Hope you are feeling a lot better!

[@psin4953]

@ConanLiuMD thank you so much for responding! Although, I did ask the doctors and nurses questions, I wasn't able to look up information myself. I tend to overthink and felt like I wasn't making an informed decision about my treatment. So, thanks for putting my mind at ease. They gave me a bunch of other vitamins as well, cut back on iron and will be monitoring my levels for the next few months. Take care and continued success in all you do!

[@adriennenixon9520]

What about mean cell volume(MCV)? A family doc told me once if MCV was below 80(microcytosis), along with low hemoglobin, it’s iron deficiency. There can significant RBC morphology on the peripheral smear as well.

[@ConanLiuMD]

MCV

[@shavoneaddy5818]

I learned that a low MCH and a low MCHC could also signal iron deficiency. I've had all of those at one point, a low MCH, MCHC, and MCV - along with target cells and rouleaux formation. My MCV is corrected by my MCH and MCHC are still low (hypochromic microcytic anemia).

[@jaiminelson7004]

I’m not absorbing very well. I’ve been doing it for five months and now I am still way exhausted that I can hardly even pull myself out of bed daily basis.

[@relaxmuse4496]

Increase your vitamin C intake. I had to double what I was already taking before we saw the iron pills have any effect.

[@plok9408]

This is a great review! On oral iron scheduling, the main study that examined the scheduling, looked at oral iron daily for 15 days vs oral iron every other day for 30 days then said it’s equivalent. This makes no sense compared to real world because in the real world someone taking it daily would have the opportunity to take it for 30 days straight which would likely produce higher iron levels. If a patient can tolerate oral iron daily or even BID then I recommend to use it.

[@coder001]

Thanks didn’t know about the every other day part 🙏

[@marushla]

Awesome as usual ! Loved it !

[@armchairtourist2039]

Awesome overview. Subscribed. Cheers.

[@ferrilgabe]

Great video! Thank you! I'm going down a research rabbit hole on iron and ferritin. My ferritin was down at 23 about 10 years ago, the normal range was 22 so I started supplementing because I was feeling fatigue and worsening ADHD symptoms. I got it up to 35 a year later when it was checked, but then in my last check up it was back down at 27. I have been reading studies about iron deficiency being associated with worse ADHD, and supplementing with iron improving symptoms, so I'm trying to bring it up now. I feel very let down that I didn't more aggressively correct my levels when my ferritin was 23, cause I thought I was just at risk of being deficient and didn't know about iron deficiency without anemia at the time. I'm wondering why Kaiser (and apparently most healthcare systems) have normal ferritin value cutoffs of 22 or even lower, when it seems like below 30 is definitely deficient, and people can still be deficient even up to levels of 50 or 100? At my last checkup the doctor said everything was fine, but I'm in the deficient range, with symptoms of deficiency. Thanks!

[@vickywinifred3287]

What did you do to bring your levels up or to start feeling better

[@Chickitychick]

Seriously frustrating!

[@saliha6767]

Thank you for this wonderful video! I would also love to hear your comments about anemia in the hospital setting. Most of the IDA patients have increased ferritin levels due to their acute illness etc. But it is also a great opportunity to detect IDA and discharge the patient with PO/IV iron rx. So how do you approach these patients whose labs overlap and not clear if it is IDA or ACD? Do you check hepcidin etc. ? Thank you again!

[@ConanLiuMD]

This is actually something I struggle a bit with too! I think the way you practice can really vary. I know a lot of people try to avoid checking iron studies in hospitalized patients in the first place since they feel it would be inaccurate. But like you I do feel like it’s a great opportunity to detect IDA and get them started on treatment so I do actually like to test quite a bit. If you read UpToDate, they recommend treating if iron sat is low even if ferritin is elevated, as long as your clinical suspicion for IDA is high. Since I read that I’ve definitely been leaning more towards the side of treating for some of these borderline patients, and it’s a great opportunity in my opinion for outpatient PCP to recheck the iron levels in 4-6 weeks and also get endoscopy / other studies that might be necessary started earlier!

[@mmctaggart3012]

Dr Liu, My daughter suffers with very low Ferritin (3 on last test!) and has fatigue and restless leg and all the other debilitating symptoms. She has had 6 infusions, only for the levels to eventually drop and then need more infusions. The last infusion of Injectifer (ferric carboxymaltose) caused an almost immediate allergic skin reaction of severe bumps like huge hives. I am curious as to why the medical community always uses elemental iron rather than the easily absorbed Heme Iron version? I know there are several supplements on the market, and they claim to not cause any constipation nor do they react with foods. Is it a purity issue? Thanks for any info and the informative video!

[@ConanLiuMD]

I'm so sorry your daughter has suffered from such severe iron deficiency, and that truly sounds like a nightmare to deal with. I am curious, have they identified a cause for why her iron levels are so low? That would be the primary thing I would want to know in someone with such refractory iron deficiency. Regarding the elemental iron vs heme iron version, I actually don't know anything about it or if there is any literature on it. All the main studies done have been with elemental iron. Do you know if there is good evidence for using this heme iron? I am sometimes a little skeptical of "over the counter alternatives" to what we usually use, since sometimes they make broad claims that aren't backed up by literature (and they usually charge patients more in order to sell these products compared to normal supplements).

[@mmctaggart3012]

@@ConanLiuMD thank you for answering, and no we do not have a cause for the low iron. She has been through all GI tests including the pill cam, Rheumatology bloodwork, GYN had her on the pill to stop all blood loss for a while, she even had a tilt table test to determine if it was POTS causing the dizziness etc. All negative… very frustrating to not be able to treat the source of the issue.

[@strech640]

A ferritin of 3? Have you ever looked into doing a parasite cleanse? I can almost guarantee this is a problem. Parasites eat our iron stores. A ferritin below 50, is most often Parasites. Check out Mrs. Kim Roger's parasite clease. Always start with making sure drainage pathways are open. Bowel movements preferably 2 times per day. She may need several rounds. Take a small break. Aprox 1 month. May need to Repeat to kill any eggs that have hatched. Good luck!!

[@angiebaby9981]

​@@mmctaggart3012I use the Heme iron because it derived from meat. It also doesn't make my constipation worse and I have no stomach issues.

[@bonez3452]

always great, keep it up brother! Intern year is approaching!

[@ConanLiuMD]

You got this!!

[@job.7371]

hello! i'm currently studying iron absorption. Do you mind sending me some sources that confirm supplementing every other day being more beneficial than everyday? Thank you!

[@ConanLiuMD]

pubmed.ncbi.nlm.nih.gov/31413088/#:~:text=In%20iron%2Ddepleted%20women%20without,is%20given%20on%20alternate%20days.

[@shavoneaddy5818]

Hi Dr Liu - I hope you're having a good day. Can you explain how to increase the saturation level? I had two infusions Venofer at the end May beginning of June - my ferritin is 188 but my saturation is 10. As a nurse I've tried to figure this out but I really don't know what to do. To be clear, I don't have IDA but ID. Thanks in advance.

[@ConanLiuMD]

Hi Shavon, yeah that is a tough scenario and I don't really have a clear answer. I would probably see if your primary care doctor would want to trial oral iron supplementation for a few months to see if that helps correct the problem. The other thing to note is that if you aren't having any significant symptoms or anemia from the low iron saturation, we don't necessarily need to correct the number just because it's low on a lab test. Could be best just to check it / monitor regularly in that scenario rather than trying to aggressively treat it!

[@shavoneaddy5818]

@@ConanLiuMD Thanks for your response, it's really appreciated. I am still having symptoms which include dizziness, tiredness, and dyspnea. I will speak with my hematologist about going the oral route with iron pills for a while to see if that helps, thanks for that suggestion. Hopefully, my ordeal will be situated sooner as opposed to later. Thanks again, and keep up the great videos! Have a good day!

[@jaiminelson7004]

OMG YOU ARE THE BEST …. Thank you so helpful. My saturation of irons very low and my faring level is very low.

[@Fitzrovialitter]

What is a "faring" level?

[@natnut2008]

Great lecture.

[@k.i.1700]

I'm really loving your videos Dr. Liu. If a patient has anemia and an active infection (like a UTI), I've been told that ferritin is an acute phase reactant so it will appear higher than it really is. Could a clinician use this reasoning to give iron sucrose to treat low iron despite the ferritin being high? Is this sound reasoning?

[@ConanLiuMD]

Those situations are definitely a lot more tough! I'm not sure if there is any clear answer or evidence for it - but if suspicion is high and transferrin saturation is

[@k.i.1700]

@@ConanLiuMD Thank you for your explanation!

[@alfredopampanga9356]

@@k.i.1700 He should have said that even when there’s no anemia the red cells show evidence of iron deficiency. The red cells will be smaller ( microcytosis) and less coloured ( hypochromic) If this is seen that’s strong indicator of iron deficiency without anemia

[@chlatepdng]

How about ferrous fumerate?

[@Veronica-tn2xc]

I'm taking it but it's not helping me.

[@Neilliam]

another great one. I’m literally about to be the Christina yang of my class bc of you haha

[@ConanLiuMD]

😂 love it hahaha

[@Maroc1406]

Thank you brother ❤ from germany

[@alfredopampanga9356]

You seem to conflate high ferritin when it’s an inflammation marker with high iron stores. One cannot assess iron stores in a context of inflammatory disease by the use of ferritin levels That’s one bone marrow biopsy comes into its own

[@max0192]

My result came in today: Hb 135 Haematocrit 42 Ferritin 22 Doctor gave me iron supplement to take for two months. What's your thought?

[@ConanLiuMD]

You are only borderline anemic but the ferritin is definitely quite on the low side, seems reasonable!

[@strech640]

You need a parasite cleanse. I don't know why doctors don't tell people this. It's mind blowing. Parasites eat our iron stores. A ferritin below 50 usually always points to Parasites. Mrs Kim Roger's has a great cleanse.

[@angiebaby9981]

Thank you.

[@ilyar7161]

Hi :) I'm a very fit athlete. I feel amazing day to day, eating a omnivore diet, almost no highly processed foods but my bloodwork is very strange. What's your opinion? Fe-iron is 49micg/dl Transferrin 224mg/dl Ferritin 24.3ng/dl Thanks!!

[@ConanLiuMD]

Ferritin is pretty low. What is your hemoglobin? Are you female, and if so do you have heavy menstrual periods?

[@ilyar7161]

@@ConanLiuMD thanks for the reply! I'm a male. My immunoglubulin is 254.6 mg/dl. Ive consulted with a very expirienced hematolog and he wasn't concerned at all. He said that as long as the immunoglubulin is fine, then I shouldn't be worried. He also said that eating more red meat won't necessarily increase iron. He thinks I should take supplements as long as I feel good. Is that reasonable?

[@yanicevelez3643]

My HGB is 10.6 g/dL (11.4 - 14.7 normal range), Iron Total Serum is 46 ug/dL (50-170 normal range) with a Saturation of 13.65% (20-50 normal range) and Ferritin is 5.2 ng/mL (11.0 - 306.8 normal range). I’m feeling very fatigue lately, short of breath and little tremors. I’m trying to add more iron in my diet, but is not doing to much. I don’t know if is Iron Deficiency caused by Gastrointestinal problems or by my Lupus diagnosed. I was diagnosed with Lupus years ago, after my 2nd pregnancy. I was, also, diagnosed with chronic gastritis after a endoscopy months ago, I’m taking Pantotrazole 40mg in the morning and Famotidine 40mg at night before to sleep. I don’t know if my problems of iron is caused by the gastritis medications now, Lupus or another gastrointestinal problems.

[@theblackout27]

Many patients with Lupus will have anemia. Many patients with chronic gastritis will too (untreated or treated). Patients who use proton pump inhibitors/PPIs (the class Pantoprazole is in) and/or H2 antagonists (class that Famotidine is in) chronically sometimes have anemia (not everyone). If you're still menstruating, that can also contribute. Some females simply become deficient even with what we would think isn't a "heavy" flow. Regardless, it could be one, two, or all of them combined contributing. Your symptoms most likely are from the resulting anemia - whatever the cause - but you should still go talk to your doctor especially given the shortness of breath (could be something else). It'd be reasonable to start taking a ferrous sulfate tablet every other day too as it's low risk and you definitely would benefit from the labs. With your chronic gastritis, ferrous gluconate might be easier on your stomach or some other form of iron (but these can get more expensive). You can buy many forms of iron over the counter for relatively cheap. With what you having going on, diet might not be enough for you at this point.

[@ruhullahhaghseresht6004]

If that FIRM study says there is no use in calculating because there is no difference >1000 mg, does calculation benefit people that may not have as severe iron deficiency? E.g. if the calculation suggests 500 mg, is that then beneficial to us because we can limit the transfusion to 500 mg, rather than experiencing potentially worse side effects at a 1000 mg dose? Just trying to see how this Ganzoni equation would have any clinical use.

[@ConanLiuMD]

Honestly I think that sounds like really good reasoning to me! I also am still a little unclear about the exact utility of the Ganzoni equation, since most of the time I just give 1000mg regardless. I think your reasoning sounds pretty solid though but I don't know about the evidence either way regarding that. Thanks for bringing it up!

[@xeph20]

Hey @ConanLiuMD I'm a 33 year old male and my ferratin has been low for years now (18 ferratin) but my iron is in the upper normal range (around 200) what does this indicate? My GP doesn't see anything bad in it but i think its weird. i eat a lot of meat and don't really have any symptoms (i am tired often but i that could be from many other factors like unhealthy foods and the fact that i always work night shifts ._.) Thanks for your advice

[@bigdanny9721]

Hello Dr. I’m 45y old and my ferritin level is @ 379ng/ml and my iron @76mcg/dl and my doctor said that he is not concerned, should I do further testing? 🙏

[@ConanLiuMD]

Your labs seem okay to me but I wouldn't give any professional advice to you over the internet, would continue asking your own doctor! :)

[@bigdanny9721]

@@ConanLiuMD but should I worry about my ferritin level

[@strech640]

Have you ever heard of hemochromatosis? Could be a possibility with high iron as well as high ferritin... might give you a place to start.. good luck!

[@AJ-ey4ev]

What does low transferrin mean in context of iron saturation

[@ashleyadams9874]

Why would someone have low ferritin (17) and high iron saturation 67% and iron 169 high? Is there a storage problem?

[@andreabraquet4869]

What would cause a 5 year old child to have high hemoglobin (15.4), high hemocrit (45.4), high platelets (477), high potassium (5.2), high calcium (10.6) and high iron saturation (46%), normal ferritin levels?

[@ConanLiuMD]

You should definitely refer to your pediatrician for medical advice, but in an adult patient those numbers would not concern me at all!

[@jackrandom4893]

My ferritin is just below midrange. It was low My transferrin and tibc are both low though but coming up. Do the transferring and TIBC take time to catch up?

[@elisabyler3421]

What does it mean if ferritin is low but iron saturation is high?

[@ConanLiuMD]

That's a little difficult to tell, how low is the ferritin? If extremely low I would lean towards iron deficiency.

[@strech640]

You more than likely need a parasite cleanse. Parasites eat our iron stores. Low ferritin usually points to this. Mrs. Kim Roger's has a good cleanse

[@elisabyler3421]

​@@ConanLiuMDIt was 12 and after 9 months of supplementation only up to 26.

[@flext3012]

Hello Dr what if my iron is 200 iron saturation is at 20% and Ferratin at 39 would I benefit from iron supplements? Also RBC is at high normal and hemoglobin at 17

[@janmartell9792]

I'm not a doctor, but yes you would benefit from it. 39 is low

[@VishalRaoOnYouTube]

Any lifestyle changes that lower iron or reduce iron absorption? How about supplements that induce this? It's been 40 years since I had iron issues (I had anemia as a child). I just had a 10 days ago that showed an iron saturation of 10% with Iron=50, TIBC=485, UIBC=435, Ferritin=12. Maybe frequent (monthly) bloodwork causing this? (I'm a biohacker, male, 43 yo).

[@theblackout27]

The most immediate ones that come to mind are 1) vegetarian or vegan diet (especially ones that exclude certain acceptable foods that are high in iron, like you avoid lentils, etc) 2) Heavy dairy consumption 3) If you eat tons of rice (certain kinds) 4) Celiac disease (gluten enteropathy) or other GI malabsorption diseases 5) Poor overall intake 6) Smoking 7) Heavy tea or coffee consumption If you're just getting small draw a month, I'd imagine most healthy individuals would be able to compensate for it. If they're taking quite a bit of blood, it wouldn't be a bad idea to grab a bottle of ferrous sulfate from the pharmacy and take it every other day for 2-3 weeks after each draw. You would have the benefit of hopefully being able to retest to see if that helps within 2-3 months.

[@VishalRaoOnYouTube]

@theblackout27 I stopped megadosing Turmeric and my iron levels are creeping up again. Thanks for your thoughts. Of the seven risk factors you listed only #1 applies to me.

[@ceciliabelgica2023]

my case was not mentioned...Ferritin in 24 ug/L (this is Canadian way of testing)(they indicate probable iron deficiency)...Red Blood Count 4.3 10^12/L...Hemoglobin 144g/L...Hematocrit 0.41 L/L...Mean Corpuscular Volume 94.4 fL....mean Corpuscular Hemoglobin 33.3 pg (with indication it is HIGH)...Mean Corpuscular Hemoglobin Concent 353 g/L...iron level 32 umol/L...Total Iron Binding Capacity 49 umol/L..Iron saturation 0.65 (with indication it is HIGH) so what is my problem????

[@SuperCelliott]

I have a lot of weird lab numbers involved with iron.I see my doctor Thursday. I’m pretty sure it’s anemia. Wondering if he’ll recommend iv or oral

[@lizzerlou2042]

Thank you!!!

[@rodrigsantsil]

How useful is knowing your transferrin vs your transferrin saturation? I can't understand why my doc ordered my serum iron, ferritin , transferrin, but not my transferrin saturation. My transferrin is 269mg and ferritin 41(very low), serum iron os totally useless, but I'm afraid I'll have to look for another doctor. The previous one didn't even bother to order my transferrin. Sad!

[@chrismyers9951]

Must know about copper or you don't have the whole picture. Morley Robbins.

[@Km-cj6ej]

Wish you were my Dr. I need iron infusions I can tell my feet are freezing again. I’m getting horrible anxiety again, fatigue. Pain in my legs , tingly feet. This happened to me back in 2022 my ferritin was 11 for almost 2 years finally dr after 2 years had me do 5 infusions! I felt like a new person anxiety went as fast as it came! Well I’m starting to feel same symptoms sure enough my ferritin has dropped again 21. I’ve emailed dr he just says 21 is ok how is it ok if I’m having horrible symptoms . I have to work and this is a nightmare can’t see OB till next month. So by then it will drop even more and yes I’m taking the iron pill and it’s worse on me than the infusions. I can see why people drive acrosss the border. We get no help here anxiety and panic attacks aren’t fun at all I don’t wish them on anyone and my dr could help me by giving me a infusion and he doesn’t!

[@PinkFlowers365]

very helpful tysm

[@crystalmoore7758]

I had iron infusions and after 8 week s labs came back ferritin high at 494 and iron sat 23 , iron 65 , hgb 12.5. mcv and mch low. Mpv high. Rdw high . Is this normal ?

[@ConanLiuMD]

Possibly some mild iron overload, sounds like the infusions worked 👍

[@davidford8539]

What to do when hemoglobin is normal, but ferritin saturation is low

[@NaWesolanute]

Grass fed Beef liver o blood with liver and spleen my level iron go to high .

[@peterpan8147]

Infusion?

[@k.i.1700]

Would it be possible to make a video on interpreting LFTs? :) Just thought I'd throw it out there.

[@chinthanaillukwatte]

❤

[@goldstar846]

wow.this was pretty disappointing.Im no MD and know more about iron than you haha what about heme and non heme....natural sources with better absorption? oh right...if it isn't synthetic factory made toxic crap...it doesn't count for doctors does it.

[@crispy566]

No sources in the presentation? If this was a university presentation it would just be an instant fail. Seems like you need to go back and do some education about how to do presentations properly, or just not do them at all if you cant provide sources/in-text references. Laughable