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Your Good Health: Iron still isn’t being absorbed properly amid iron infusions

“Microcytic anemia” means that your blood count is too low and that your red blood cells are smaller than they ought to be. I
Dr. Keith Roach

Dear Dr. Roach: I was prescribed iron for a low iron level due to “microcytic anemia.” I couldn’t tolerate oral iron because of constipation and hemorrhoids, so my doctor prescribed iron infusions. But I had an allergic reaction, and I continue to have sore places all over my body.

I am not in great pain, but I’m curious as to whether this is going to be worse as I age. How do I know if this has affected my internal organs in any way? I have read that iron overload disorders can lead to the buildup of iron in tissues and organs. This can cause an increased risk of arthritis, cancer, liver problems, diabetes and heart failure. I was tested for hemochromatosis (which I do not have), so he does not know why my iron level remains so low.


“Microcytic anemia” means that your blood count is too low and that your red blood cells are smaller than they ought to be. Iron deficiency is a very common cause of this, but there are many other causes. The diagnosis of iron deficiency must be confirmed by iron studies, including your iron, transferrin and ferritin levels. These are all used to suspect the diagnosis of iron deficiency, although a definitive diagnosis can be made by a bone marrow biopsy. I’m going to assume that your doctor has confirmed your iron deficiency.

The main concern I have is your low iron. There are three big categories why that might be: Either you aren’t getting enough iron in your diet, you aren’t absorbing it, or you are losing it faster than you are absorbing it. Most people get adequate dietary iron, so the most common issues are normally insufficient absorption or excess loss.

Multiple conditions can prevent iron absorption, but the most common ones (apart from the surgical removal of part of the intestine) are celiac disease, atrophic gastritis, H. pylori infections, and medicines, especially antiacid medicines (proton-pump inhibitors, H2 blockers, and antacids like Tums).

Iron loss is the most dangerous case because undiagnosed blood loss, especially from colon cancer, can go unrecognized for years. Menstruating women often get mild iron deficiency, but any man or postmenopausal woman with iron deficiency must be considered for colon cancer.

Reactions to new iron formulations are rare. (Anaphylaxis in 2-7 cases per 10,000 is reported, but this may be an overestimate.) I have never seen a case of persistent body pain after an iron infusion.

Finally, you don’t need to worry about iron overload. If you don’t have hemochromatosis, your body won’t absorb iron if you don’t need it. Still, your doctor should only be treating you with iron as long as your iron levels are low.

Dear Dr. Roach: My significant other will use the same toothpick to clean his teeth after several meals. My suggestion to replace it after each use has gone unnoticed. Your thoughts on this would be appreciated. I will let it go if you advise as such.


There probably isn’t much risk of infection, but toothpicks are cheap. He can afford to use a new one every time.

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 [email protected]