Iron supplements/Anemia bad?

Our GP called today to tell us that our Daughters iron stores are quite low. She's recommending going back on an iron supplement. She took Palafer,(Ferrous Fumerate), for several years, which managed the anemia well, but because she was always prone to constipation, didn't want to keep taking it. She's been off of it for about a year.

I started doing some home research, and found quite abit of information indicating that oral iron supplements can cause Crohn's disease activity to worsen considerably.

The recommendations were for systemic iron repletion only. I suppose that means IV iron infusions.

Does anyone have any info regarding this? Looking for some advice, as I'm a little apprehesive to get her started back on oral iron.

Thank-You NCoT,

Just wondering, where do you have to have this done, and how often? I'm assuming you can't have this done at the Dr,s office.

You're right about the effectiveness of oral iron. When ever taking it in the past, it took up to 6 months to show improvement.

I see, sorry to keep at you on this, but we're hoping to see our family Dr. tomorrow and run this by her.

So is the idea to have one infusion every few months? How long should one infusion keep anemia at bay?

Since you've obviously been dealing with this for some time, have you heard about oral iron exacerbating or actually causing disease activity?

Thanks again for replying.

As gumby said, how many transfusions you need to have, and how often, depends. Crohn's often leads to anaemia, either indirectly through anaemia of chronic disease or more directly through GI bleeding. Certain meds can also cause anaemia by suppressing bone marrow function, in particular the chemotherapy ones, eg 6MP, Imuran, methotrexate. (It's not inevitable or even likely they will, but it is a possibility.)

So really, the only way to know if you need an iron transfusion is to keep track of haemoglobin and ferritin levels via blood tests. Me, I can tell when I'm severely anaemic without any blood tests, because I start getting bad restless legs and breathlessness, but that wouldn't convince a doctor of it.

All I know about iron injections is that they are meant to be incredibly painful and are rarely used anymore :-/ You could always ask your doctor about having one if you are still interested. Personally, I wouldn't be too worried about a bad reaction with an iron transfusion. An anaphylactic reaction is a rare one, no matter what, but you can reduce the risk still further by picking a newer iron formulation (eg something other than Venofer or Cosmofer), having the infusion rate slowed down and/or splitting the dose over two or more smaller ones.

As for methotrexate, it's not inevitable it will make your red blood cells go out of whack. It's like with any med: some side-effects will effect some people, but not everybody. In my case, it was fairly obvious to me it was the MTX, because my haemoglobin had remained steady at around 10-11 for a year on Remicade, then was down to 7 about two months after starting MTX. I hadn't suddenly started pooping toilet bowfuls of blood.

In your case, it's impossible to say whether MTX is making your anaemia worse. It might be, but Crohn's is certainly known to cause anaemia as well. However, what I can say is that a low-dose oral supplement will probably never be enough to resolve your anaemia. That's because by the time you reach the stage of having iron-deficiency anaemia (ie low haemogloblin blood levels), you are already at an advanced stage of iron deficiency. This is 'cos your iron stores (ferritin) are depleted first of all and it's that depletion which leads to haemoglobin in the blood dropping.

The tl;dr version

Get iron transfusions or, if needs must, injections.

Hi there,

I have been anemic ever since having crohns, I take an iron supplement called Feosol, it is Carbonyl Iron, it is not hard on the stomach and digest easier so as to not make you so consitpated, I have been taking it for about a year now and my levels are now just above normal I think 13 when last checked, it was running at about 8-9, I take two a day and they agree with me well I have a very sensitive tummy, and very prone to constipation.  I get it at wal-mart its a little more spendy than just the regular Iron supplements but well worth it! After telling my doc. about my constipation and how the other iron would turn my poop very dark to black he did a little research and told me to try this kind, just make sure it is Carbonyl Iron.  Hope this helps!

Thanks JLCat,

There seems to be a concern now that any oral iron supplement could exacerbate crohn's activity.

That, combined with the fact that she is always battling constipation at the best of times. Even the most mild oral iron might be a problem for her.

Julia,

Thanks for relating your experience. So far I've been told that the infusion can take anywhere from 20 minutes to 6 hours. If we go that route, I'll prepare for the latter.

How often do you have to have an infusion? Again, I've heard that it can last about 6 months.

Not sure about b12, but the Dr. did say her Vitamin D was low as well.

We have appt's with our GI next week, and our GP the week after. Hopefully we'll have some answers after that.

Tom.

Thanks again Julia.

No resections to date. Only symptoms from the anemia is being very tired.

Tom.