In spite of taking Orofer XT my mother's Hb is low. What is the reason?

Question

Hello doctor,

My mother's iron levels are low. Four months back, we had done her blood tests and got to know that her iron levels are low. She had Orofer XT for two months, but still, they seem to be low. Also, she had a urinary infection a week back and took a course of antibiotics for that. I have attached her recent blood reports. Please advise. She is diabetic and hypertensive and currently on the following medication: Glycomet GP 3/850 one in the morning and one at night, Voglibose 0.3 in the morning, Telmisat AM 5 mg, Orvas 5 mg, Nexito 20 mg, and Alzolam 0.5 mg.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

Her iron absorption seems to be less. Improvement with vitamin C supplements could be helpful. Iron absorption improves with vitamin C rich diet or citric acid rich fruits.
She need to avoid diet factors which are impairing absorption like phytates and fibers in whole grain cereals and nuts, the calcium and phosphorus in milk and supplements, the Ethylenediaminetetraacetic acid (EDTA), in food additives and tannic acid.
Tannic acid is present in tea, coffee, nuts and some fruits and vegetables. All these should be avoided for at least two to three hours after Orofer XT (combination of iron and folic acid).
If it does not improve, then the injectable iron can be taken. At present it is not seriously low hemoglobin or iron and so Orofer XT with vitamin C supplements can be tried for another two months.
Urinary tract infection during summer is common due to dehydration. More hydration of at least five to six liters of water should be helpful and prevent further risk of urinary tract infection.

Answer 2

Hi,

Welcome back to icliniq.com.

Based on your query, my opinion is as follows:

Yes, she can take Orofer XT anytime during the day. She can take it as long as necessary for iron to improve. There is no side effect, as the body has a way of stopping excess iron absorption.
Stopping it was not necessary; however, she can start it now to improve it. Make sure she is not taking many medications at the same time as she might forget life-threatening medication without her knowledge.
Iron rich foods include red meat, pork, poultry, seafood, beans, dark green leafy vegetables such as spinach, dried fruit such as raisins and apricots, iron-fortified cereals, breads, pastas and peas.
Take antibiotics for at least two to three days to work and if she has no symptoms and urine is clear now, then no need to worry about turbid urine.
Ask her to maintain good hydration. If the urine is still turbid, then get a urine microscopy for pus cells.