Low iron absorption needs re-evaluation New facts dispel old fears, Sagittarius

Dear Dr. Roach: My daughter’s iron level has been dangerously low for years. One measurement was as low as 5, but mostly it is between 9 and 15. She took iron pills, which affected her in many other ways.

She was given one iron injection, which affected her negatively. She refused the second one. She has been on an antidepressant and an antipsychotic med for bipolar disorder for 10 years. She is 45.

They cannot figure out why her iron stores are so low. She had an endometrial ablation done two years ago, and her menstruation stopped. Her iron stores are still low. She is taking iron pills to keep her functioning. What causes a person to NOT store iron? — M.S.

I don’t think the issue is her being unable to store iron; rather, the issue probably is that she isn’t absorbing it. Whatever endometrial problem she had that required ablation probably caused her to bleed, and the bleeding caused her to reduce her iron stores. Over time, her bone marrow and liver ran out of iron almost completely. (The blood levels of 5-15 indicate very little iron in the blood. A low ferritin level would confirm low iron stores.) Iron by injection is an effective way of replacing iron. There are several formulations available, some of them quite new (with fewer side effects than older preparations), so it may be worth trying a different preparation from the one she did not react well to.

If she is not replenishing her iron stores despite adequate oral iron, then either she is not absorbing it or she is losing it elsewhere. Both are possible.

Ongoing blood loss can confuse the issue. Hidden inflammatory bowel disease, such as Crohn’s, may produce blood loss with no symptoms.

Given how long your daughter’s problem has been going on, I think it’s time for a fresh evaluation and rethinking of her issue.

Write to Dr. Roach at ToYourGoodHealth @med.cornell.edu.

Today’s Birthday: Let your heart lead this year. Collaborate in community for resilience with changes.

To get the advantage, check the day’s rating: 10 is the easiest day, 0 the most challenging.

Cancer (June 21-July 22) (8) A professional possibility tempts. Figure out what skills you lack. Avoid a conflict between love and money.

Leo (July 23-Aug. 22) (7) Discover new terrain close to home. Avoid traffic or the hassle of long-distance travel. Have patience with delays.

Virgo (Aug. 23-Sept. 22) (8) Increase attention to financial matters. Adapt to circumstances. Make necessary changes.

Libra (Sept. 23-Oct. 22) (7) Cooperation makes a difference. Avoid arguments with your partner, especially about money. Tread carefully around another’s sensitivities.

Scorpio (Oct. 23-Nov. 21) (6) Take it slow and easy. Push too hard, and you might break something. Stay frugal. Keep practicing for a test.

Sagittarius (Nov. 22-Dec. 21) (8) Don’t make assumptions. Abandon false hope. New facts dispel old fears. All isn’t as it appears.

Capricorn (Dec. 22-Jan. 19) (8) Make home repairs and upgrades. Get rid of stuff you don’t need anymore.

Aquarius (Jan. 20-Feb. 18) (7) A problem requires attention. Make sure you have the facts. Challenge the status quo. Try a creative idea. Polish your presentations and materials.

Pisces (Feb. 19-March 20) (8) You need to break eggs for an omelet. Don’t overspend. Stay pragmatic. Compromise for best value.

Aries (March 21-April 19) (8) Ponder your upcoming action. Stay focused. A hidden danger could arise. If it goes against your grain, turn it down.

Taurus (April 20-May 20) (5) It’s not a good time to gamble or travel. Lay low, and keep expenses down. Rest and recharge. Avoid arguments.

Gemini (May 21-June 20) (8) Others demand your attention. Don’t let it interfere with the responsibilities you already have. Resist temptation to gossip or chatter.