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Recurrent anemia
I am a 28-year-old female with recurrent iron-deficiency anemia for several years. My recent blood tests (18 Aug 2026) show Hb 9.4 g/dL, MCV 65.84 fL, serum iron 15.8 µg/dL, transferrin saturation 3.94%, RDW 17.1%, Ferritin- 7.8, vitamin D 6.01 ng/mL, B12 182 pg/mL, calcium 8.37 mg/dL and ESR 32.
I have heavy menstrual bleeding and have required several iron infusions in the past, but the anemia keeps recurring. I currently have significant fatigue, hair fall, irritability and mood changes. Also, gut issues.
My questions:
1. What could be causing my recurrent anemia despite IV iron?
2. What tests should I have to investigate heavy menstrual bleeding, iron malabsorption/coeliac disease, or other causes of recurrent iron deficiency?
3. Should I see a gynecologist, hematologist, or gastroenterologist?
4. What treatment would you recommend for my iron deficiency, severe vitamin D deficiency and low B12?
5. How can I prevent the anemia from recurring?
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Your reports suggest significant iron-deficiency anaemia (Hb 9.4 g/dL, ferritin 7.8 ng/mL).
Treatment:
- Ferrous ascorbate + folic acid (e.g. Orofer-XT / equivalent) – 1 tablet once daily after dinner.
- Vitamin D3 60,000 IU (e.g. Syp. LD3 60K) – 1 once weekly for 8 weeks, preferably after a meal.
- Vitamin B12 1000 mcg – once daily for 8–12 weeks.
Please consult a gynaecologist for evaluation and control of heavy menstrual bleeding, as this is likely contributing to recurrent iron deficiency. Repeat CBC and ferritin after 4–6 weeks.
Next Steps
- Start the above supplements and continue regularly.
-Do Gynaecology consultation on practo for heavy menstrual bleeding.
- Repeat CBC, ferritin and iron profile after 4–6 weeks.
- If anaemia persists/recur despite treatment, evaluate for coeliac disease/GI blood loss.
Health Tips
Avoid tea/coffee and preferably with water or a vitamin-C-rich drink. If you develop severe breathlessness, chest pain, fainting or very heavy bleeding, seek urgent medical care and discuss on practo
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Common thing is common. As per your history, anemia most likely be secondary to your menstrual history. Dont overrate iv infusions as they are just as effective as oral iron. If you keep losing blood, no iron infusion is going to be effective.
Go to a gynaecologist. And a pelvic US may help in ruling out conditions
Next Steps
Till then make sure you are consuming enough protein and iron.
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