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I had gastric bypass in 2014. Has anyone experienced or know someone who has experienced a condition called "Iron deficiency WITHOUT anemia"? It is also sometimes called HWA (Hypoferritinemia without anemia). This is a condition where ferritin is low but hemoglobin, RBC and other related blood markers are normal . I am experiencing chronic worsening symptoms that are identical to Iron deficiency anemia (weakness, fatigue, light-headedness, brain fog) but my Hematologist doesn't seem to believe this is a real condition. In other words, since my red blood cell count and hemoglobin are fine, he believes these symptoms are not due to low ferritin. Can anyone recommend a hematologist that has experience with bariatric patients in Maryland?

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Yep, I have that.
You need a doctor that can, to put it politely, look outside the parameteres of medical school and reference levels.

You might also have your Vitamins checked, and please have Iron infusion.

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Thank you MsMocie for your response. I have had one infusion and ferritin levels rose and then fell precipitously even with Iron supplements. Have you experienced the same thing? Do you require regular infusions? Do you know what the "goal" ferritin level is for you after an infusion?

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11 hours ago, alegzis said:

I had gastric bypass in 2014. Has anyone experienced or know someone who has experienced a condition called "Iron deficiency WITHOUT anemia"? It is also sometimes called HWA (Hypoferritinemia without anemia). This is a condition where ferritin is low but hemoglobin, RBC and other related blood markers are normal . I am experiencing chronic worsening symptoms that are identical to Iron deficiency anemia (weakness, fatigue, light-headedness, brain fog) but my Hematologist doesn't seem to believe this is a real condition. In other words, since my red blood cell count and hemoglobin are fine, he believes these symptoms are not due to low ferritin. Can anyone recommend a hematologist that has experience with bariatric patients in Maryland?

Your Hematologist is useless...

If you want to see if Iron is responsible for your symptoms, take an iron supplement, the first thing that will resolve upon taking an iron supplement almost immediately is the feeling of being dizzy (especially when walking more than 20 - 40 feet in the morning)... if that resolves within 24 hours of supplementation, then you're almost assuredly iron deficient.

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Just a thought - What’s your blood pressure? Low blood pressure has the same symptoms of dizziness, fatigue, weakness & doughiness in the head. I have that every day but with good Iron levels. It may be contributing to your symptoms.

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14 hours ago, alegzis said:

I had gastric bypass in 2014. Has anyone experienced or know someone who has experienced a condition called "Iron deficiency WITHOUT anemia"? It is also sometimes called HWA (Hypoferritinemia without anemia). This is a condition where ferritin is low but hemoglobin, RBC and other related blood markers are normal . I am experiencing chronic worsening symptoms that are identical to Iron deficiency anemia (weakness, fatigue, light-headedness, brain fog) but my Hematologist doesn't seem to believe this is a real condition. In other words, since my red blood cell count and hemoglobin are fine, he believes these symptoms are not due to low ferritin. Can anyone recommend a hematologist that has experience with bariatric patients in Maryland?

Is there a specific reason why you suspect HWA? For example, have you recently had lab tests that indicate low ferritin levels? Iron deficiency, including HWA, is common after bariatric surgery. Any doctor or surgeon can order lab tests for you: a standard bariatric post-op iron panel would typically include serum ferritin levels, serum iron, transferrin saturation, total iron binding capacity, mean corpuscular hemoglobin, and hemoglobin level. There is also a specific test for HWA that you can request called HFE (hyperferritinemia panel). Since you’re possibly symptomatic, perhaps some of these tests would be covered by your health insurance, if you have it? It's best to have blood work done prior to starting any new oral iron supplementation, in order to get an accurate base reading.

The symptoms you've described aren't limited to iron deficiency anemia, and there can be many other causes of these symptoms (as well as a number of other conditions aside from bariatric surgery that can cause HWA), so please insist on having this investigated. Would it be possible to discuss your symptoms and be tested by your regular physician, your old WLS clinic, or a local bariatric clinic in your area? I hope you're able to get this resolved quickly, and that you feel much better soon.

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10 hours ago, PollyEster said:

Is there a specific reason why you suspect HWA? For example, have you recently had lab tests that indicate low ferritin levels? Iron deficiency, including HWA, is common after bariatric surgery. Any doctor or surgeon can order lab tests for you: a standard bariatric post-op Iron panel would typically include serum ferritin levels, serum iron, transferrin saturation, total iron binding capacity, mean corpuscular hemoglobin, and hemoglobin level. There is also a specific test for HWA that you can request called HFE (hyperferritinemia panel). Since you’re possibly symptomatic, perhaps some of these tests would be covered by your health insurance, if you have it? It's best to have blood work done prior to starting any new oral iron supplementation, in order to get an accurate base reading.

The symptoms you've described aren't limited to iron deficiency anemia, and there can be many other causes of these symptoms (as well as a number of other conditions aside from bariatric surgery that can cause HWA), so please insist on having this investigated. Would it be possible to discuss your symptoms and be tested by your regular physician, your old WLS clinic, or a local bariatric clinic in your area? I hope you're able to get this resolved quickly, and that you feel much better soon.

This is a history of my ferritin levels while taking iron supplements:

OCT 2018: 8 (out of range low)
NOV 2018: Received Infusion (Injectafer 1000 mg)
DEC 2018: 101 (normal range)
MAR 2019: 56 (normal range)
APR 2019: 48 (normal range)
FEB 2020: 20 (out of range low)

Red blood cell count, hemoglobin, hematocrit, etc, were all normal for all of the above tests. For menstruating women this is a more common condition, obviously because of blood loss. However, I am man with no sign of blood 'leakage'. I've had endoscopies, colonoscopies, MRIs, etc.

You mention other conditions that can cause HWA -- could you name some?

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Pre-surgery my ferritin was really low (11) but my blood counts, etc... were all good. I had extreme fatigue. Dr. had me take an Iron supplement (OTC but primarily referred for diabetics) any my ferritin levels rose and I felt better. I've been supplementing iron since surgery and my levels are normal now.

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