Pt with serum iron, not improving

[Guest guest]

Hi - I have a pt with serum iron that dropped low 6 months or so

after surgery (she had a bleeding ulcer) and has not recovered. I

just found out the iron supplement she is taking is 20 mg iron

bisglycinate (I don't know if that is 20 mg elemental or 4 mg

elemental) so maybe she just isn't taking enough. We even checked

her vit A, Cu, Zn (all fine). Her info is below and I appreciate any

input. Also, does someone have an alogrithm for treating iron def

anemia? Most of the ones I've looked at use ferritin which we don't

get since we get more iron studies.

Thanks in advance for any thoughts,

Debbie Petitpain, MS, RD

" MB " had gastric bypass surgery on 11/1/06 at which time she

weighed 261 lbs. Her IDEAL BODY WEIGHT: 130 lbs and her Orig

Excess Weight: 131 lbs. Today, her WEIGHT IN LBS: 152 lbs. She has

lost 109 lbs overall or 83% of original excess weight.

5/31/07

% Fe sat = 23

Fe = 96 mcg/dl

Transferrin = 320.9

MCV = 80.1 L

MCH = 25.1 L

10/29/07

% Fe sat = 9 L

Fe = 40 mcg/dl L

Transferrin = 307

MCV = 82.9

MCH = 27.8

4/24/08 - Pt is taking MVI: One per day (probably Flintstones with

iron), Mentanx (with B12, folic acid, B6 for low homocysteine), one

calcium citrate pill, Zinc, biotin - instructed to add 65 mg

elemental Fe/day and did this BID until July when she switched

to " gentle " iron

% Fe sat = 13 L

Fe = 52 mcg/dl

Transferrin = 296.8

MCV = 86.6

MCH = 29.6

10/20/08 - Pt taking one MVI/day (Flintstone w/iron), B12, 1 calcium

citrate pill, 20 mg biotin, 2000 IU vitamin E, 75 mg zinc 3x/wk (she

swears this keeps her hair from falling out), mentanx and gentle

iron 2/day (unsure of dose but probably too little)

% Fe sat = 10 L

Fe = 46 mcg/dl L

Transferrin = 315.7

MCV = 87.1

MCH = 29.0

Zinc = 97

Retinyl palmitatte = 0

retinol = 0.48

Copper = 113