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DEAR DR. ROACH: I’m a 66-year-old female who’s in good health. I was experiencing some dizziness and was prevented from donating blood due to a failed finger prick test. I asked my doctor to check my iron levels. All my blood work was excellent, except that my ferritin level was 19 ng/mL with an iron saturation of 18%.
When I researched my results online, there seemed to be great concern about the ferritin level since I’m postmenopausal, as some type of slow internal bleeding can occur. My doctor, however, wasn’t at all concerned, saying that he wouldn’t act on a ferritin level of 19 ng/mL with all my other labs (a complete blood count) resulting in very good levels.
I also read that the American Society of Hematology has recently changed the guidelines for what “normal” iron levels should be. I’ll be taking an iron supplement (per my doctor’s recommendation), but do I need to be concerned about the underlying cause of my ferritin level? -- Anon.
ANSWER: I’m sorry to disagree with your doctor, but a ferritin level this low does concern me, especially in a postmenopausal woman or a man. There are many causes, but some are very concerning.
The one that I was taught to consider first, as you cannot miss this diagnosis, is an advanced colon polyp or colon cancer. In my opinion, a low iron level alone, even without an anemia, should at least cause a clinician to consider this diagnosis. The new recommendations are that adults with a ferritin level less than 30 ng/mL should be considered to have iron deficiency.
Perhaps your doctor knows that you recently had a completely normal colonoscopy, so he wasn’t as worried about colon cancer. (Unfortunately, even a colonoscopy occasionally misses some polyps that can bleed, as well as small cancers.) However, there are other conditions, such as ateriovenous malformations, celiac disease, and Crohn’s disease, that can cause blood loss, prevent iron absorption, or do both.
It’s also clear now that iron deficiency, even without an anemia, can cause symptoms, which is different from what I (and maybe your doctor) learned in medical school. Fatigue and dizziness are among the most-common symptoms. I agree with iron supplementation, but a careful consideration of other causes (and usually some additional testing) is warranted in my opinion.
Finally, most blood banks check hemoglobin, not iron, so your hemoglobin may have actually been low when you were trying to give blood.
DEAR DR. ROACH: In a recent column, you suggested getting a flu vaccine in the doctor’s office. Please don’t assume that all physicians provide it in their clinic. Mine stopped doing so. — S.R.E.
ANSWER: Thank you for the reminder. My office gives out large amounts of vaccines, but many physician’s offices no longer do so. Many physicians have found that giving the vaccines takes a lot of time and energy, and they make such little money (or even lose money) that it isn’t worth it. Pharmacies now give nearly as many flu vaccines as physicians’ offices, and this trend is likely to continue changing.
Pharmacists are experts at giving vaccines, and the vaccine is the same no matter where it’s given. But I did make the assumption about getting the vaccine in a physician’s office, which is often no longer the case.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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