Severe anemia. Difficulty level: Bipolar II
February 5, 2017 6:39 PM   Subscribe

Routine bloodwork recently found that I have quite severe anemia. I'm really struggling with the cognitive and emotional aspects of it. To complicate matters, I'm bipolar II and have just been in a huge med fiasco. I'm wondering how I can cope with my symptoms better, and also how to sort out what's the anemia from psychological/psychopharmalogical stuff.

I'm prone to my iron being a little low, but this bad is new. My dr called after routine bloodwork and said I had severe anemia. She ordered more tests and when they came back, she called to say it was really severe. She said I was a hair away from needing a transfusion.

I hadn't been noticing a ton of symptoms because I've had a respiratory infection for a month now, and I chalked any fatigue up to that. The other thing going on was that I tried a new antidepressant (Trintellix) and it made me hypomanic for about six weeks. Now the Trintellix is out of my system, and I'm supposed to start Tegretol, but I wonder how much of my mood stability is because of the anemia. Unfortunately, I've just been learning that the prescriber I see is pretty awful but even more unfortunately the best option I have for now(based on where I live, not having insurance, etc). When I saw her last week, she had no idea re any overlap of symptoms and totally discarded the anemia info altogether. Is there any way to tell how much of my depression and lethargy are related to anemia so this can inform my psychiatric care ?

The bigger issue here is that I'm really struggling right now, much more so than usual. I have a few chronic health issues already, and adding one more really brought me down. I'm having mood swings that are not typical of the bipolar II, I'm angry a lot, and I'm sad and hopeless. I'm also having a lot of brain fog. I'm a music journalist, and I find I have to write down every little thing before an interview, and keeping my train of thought is awful. These are things that are not typical of my mood disorder, so I figure they are likely related to the anemia. Is there anything I can do to offset those kinds of effects of anemia? It will take a few weeks to know if the supplements and dietary changes are helping, and I'd like to have something, whether it be a habit or a supplement, to add in. (Remember that I've got the whole lethargy thing going on and can't do a ton.)
Thank you.
posted by mermaidcafe to Health & Fitness (9 answers total) 3 users marked this as a favorite
What does your Dr think you should do? Ask if you can try IV therapy iron in a hospital or an outpatient setting before you try a blood transfusion - sounds like IV therapy might be appropriate for you if your levels are severely low. IANYD.

How's your appetite? Are you able to eat normally, can you take yourself out to dinner? Clams, mussels, oysters, good quality red meat are all great sources of iron. So are most cooked beans (even from the can - convenient) and spinach, kale, broccoli and tofu, if you're not feeling the seafood or meat. Have a steak salad over a bed of spinach or kale :)

If you can stomach canned sardines, those are also a great source of iron. You could also look for iron-enriched breakfast cereals.

Ask your dr to recommend an iron supplement that's safe in combination with the other meds you are taking. It's a little surprising she didn't recommend one at the same time she delivered your test results - hm. Take it with food and water. If you can't get to your dr for a recommendation, a pharmacist can check to make sure that an iron supplement doesn't interact harmfully with any of your prescriptions. A good pharmacist can also recommend a particular supplement to you.

Nutritional deficiencies do not resolve overnight - give yourself a couple of weeks of good nutrition and supplementation before expecting to feel like your energy levels have changed.
posted by zdravo at 6:56 PM on February 5, 2017 [2 favorites]

Thank you! I will ask about IV therapy. I hadn't heard of that.

I forgot to add that I have my diet all sorted out and I'm now eating plenty of iron-rich meals. I don't think need any more tips as far as that goes, but thank you.
posted by mermaidcafe at 7:03 PM on February 5, 2017

I'm so sorry you're going through this. While I don't have bipolar, I do have pernicious anemia that was undiagnosed for a decade and I can tell you what my symptoms were like. Brain fog is a big one. It got so bad that I couldn't do simple math in my head, and I would constantly forget words in conversation. I also had extreme dizziness and depression. My iron stores always came back low in blood tests, but it turned out that despite taking iron, it was actually b-12 that I wasn't able to absorb. Now I take b-12 regularly by injection and all my symptoms are gone. If I were you I would ask your doctor if an iv iron infusion is the best course of treatment, given your symptoms. Otherwise, taking an iron suppliment (with vitamin c, so it absorbs better) would be the next best thing. Your doctor should be able to reccomend a good iron supplement, or specify the amount of mgs/ type of iron that you should be taking. I'd give it a couple of weeks to see if you're feeling better, but given how severe your doctor made it seem, perhaps a follow up conversation is in order. Oh, and one more thing, iron can be hard on your stomach, so make sure to take it with a meal. Good luck!
posted by Champagne Supernova at 7:05 PM on February 5, 2017

I have iron deficiency, not iron deficiency anemia, but I can tell you that a lot of my symptoms were the same - grinding, dragging fatigue plus irritability and brain fog/trouble concentrating. I imagine it's even worse if you actually have anemia!

I would x100 recommend going the IV iron route if your doctor agrees and thinks it's appropriate/safe for you given your other meds/medical conditions. I've had two now, and instead of spending months trying to incrementally get my very low ferritin up with iron in my diet and supplements (and dealing with the GI side effects and the frustration of timing everything just so, with Vitamin C but not calcium, etc.), I sat there with an IV for about an hour each time and read a book. I felt a very small amount of joint... weirdness directly after the first infusion, but that may have been caused by the steroid they gave me instead, and it was gone within a day. No pain, just a feeling of *noticing* my knees and ankles, etc. That was really the *only* side effect I had.

My ferritin went from about 4 to about 6 with six months of oral supplements (and side effects...), but with the two infusions, my ferritin climbed to the 40s very quickly.

So awesome, so highly recommended if it works for you/your doctor. MeMail me if I can answer any specific questions about it. Good luck!

(And try not to let yourself get too down about this diagnosis. Easier said than done, I know, but iron deficiency anemia, if that's what it is - rather than a more complex form of anemia - is pretty straightforward and easily treatable and not necessarily chronic. It's not fun, but at least it's easy to fix!)
posted by bananacabana at 7:40 PM on February 5, 2017

Yes, ask about IV iron. You'll likely need a course of treatment to both up the free levels as well as replenish your iron storage. Severe anemia can absolutely cause serious symptoms and needs to be aggressively treated.
posted by quince at 8:50 PM on February 5, 2017

Yes, severe anemia does need to be treated. At one point my hematocrit was 21 and they immediately gave me two units of packed red blood cells.

Also, make sure you know what type of anemia it is. I have thalassemia, which is not an iron deficiency anemia, so iron is not the correct treatment for me.
posted by Altomentis at 8:57 PM on February 5, 2017

Nthing the iron infusion (via IV). It made a huge difference to me.

Have you had breathlessness associated with your respiratory illness? You might find that was anemia related too. It was one of my symptoms.

As a fellow BPII who can't keep her iron levels up, I really feel for you. Hang in there, getting the iron sorted makes a huge difference.
posted by kitten magic at 9:13 PM on February 5, 2017

I had debilitating anemia, and after an infusion, felt almost immediately better. It was like a fog lifted, I can't describe how much my life changed. After that infusion, I've been able to keep my iron in check via diet and suppression of menstruation. Get your iron figured out before tweaking your psych meds; you want your psychiatric issues treated while you are as close to "control" state as you can get.
posted by juniperesque at 8:54 AM on February 6, 2017

That blows. :(
If you cannot do IV due to cost (or because your doctor refuses), can you do liquid supplements instead of pills? The good ones should be absorded quicker, and maybe you can time them to drink twice a day so you get your levels up without upsetting your stomach.

A lot of doctors seem to just prescribe iron without any comments on how to take it, so in case you don't know already (I didn't at first, because I thought I could trust doctors and anemia makes you brain-fogged, so no own research):
- take iron with vitamin C and B vitamins (plus folic acid) to maximize absorption
- do not take any calcium, magnesium or zinc within two hours of your iron supplements (that means iron-fortified cereal with milk wouldn't work)
- caffeine can deplete iron, so don't take them together and try to avoid it altogether if you can, even if you're exhausted
- my research says you should take iron on an empty stomach first thing in the morning (unless you take other meds like thyroid replacement hormones at the same time), but I find that hard to stomach and you'd have to wait two hours to get coffee and milk if you want to ensure it gets absorbed fully

If iron makes you constipated, try magnesium supplements before bed, but not within two hours of the iron supplements.

I'm so sorry you're feeling bad. I'm a vegetarian who thankfully doesn't menstruate (yeah endometriosis treatment), but my iron is still low. The good news is, once your levels are up, you should be able to keep them up with just diet and maybe small daily dosis iron pills that won't hurt your stomach. If they don't go up at all, it may be time to have your absorption levels and intestines checked out.
posted by LoonyLovegood at 7:16 AM on February 7, 2017

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