Severe iron deficiency, lupus

[ctjedda]

I am a 34 year old female with lupus and Hashimoto's thyroidits, on Synthroid, Plaquenil, and Medrol as well as Zyrtec. I have currently become severely iron-deficient anemic. Abnormal bloodwork is as follows:

Hemoglobin 11.4-low
MCV 71.2-low
MCH 22.9-low
RDW 18.9-high
Iron, total 20-low
Transferrin Saturation 5.3-low
Ferritin 4-LOW
ANA 1:640 speckled (this is typical for me)

Am I at a point with the extremely low ferritin where I would need transfusions or parenteral iron? Is this related to the lupus? I was just started on ferrous sulfate 325mg 3x/day. Is this appropriate?
Thanks, JNS

[Dr. Safaa Mahmoud]

Hello,

Your results are typical for iron deficiency anemia.

This is a condition caused mainly by chronic blood loss without adequate iron supplementation and treatment. These conditions include irregular menstrual bleeding, inadequate iron intake, bleeding from gastrointestinal due to ulcers, colon polyps, colon cancer, hemorrhoids, etc.

You have been on steroid treatment (Medrol) which is known to cause gastritis and gastric ulcers that are known to result in chronic blood loss. In addition, hydroxychloroquine (Plaquenil) is a medication known to cause anemia. Patients with hypothyroidism are also known to have anemia.

So, although chronic blood loss seems to be the most likely cause for this anemia, other causes should also be considered.

Iron infusion is usually indicated in cases of severe anemia (usually Hb below 9gm, or based on symptoms and signs), inadequate absorption (malabsorption) or when a rapid elevation of serum iron and its stores ferritin is needed.

I would advise you to continue your iron supplements and to follow up with your doctor. He might also recommend checking your thyroid function tests and an occult blood in stool test.

Hope you find this information useful.
Please keep us updated.
Best regards.