Preganancy, iron in blood and Iron stores

Patient

Q: Can you explain to me the difference between what i think is iron levels and ferritin levels, as in iron and iron stores? I have had problems with me iron stores in the past. At my last midwife appointment they took blood which showed iron levels fine but said that did not tell them ferritin levels.

This is my third pregnancy and i am absolutely exhausted all the time, which is not normal for me. I am 30 weeks now. I am getting breathless when i do anything which i put down to the fact that i am heavily pregnant and that the baby is lying transverse quite high up which i guess won't be helping. However the last week i have been having restless legs and they have felt most odd, on googling it suggests low iron. Could low iron stores be a cause even if my circulating iron levels are ok?

Doctor

A:   Your iron requirements go up significantly when you're pregnant shooting up from 18 to 27 milligrams (mg) per day. Because it's hard to get enough iron through diet alone, the Centers for Disease Control and Prevention recommend that pregnant women take a daily supplement of 30 mg of elemental iron as a preventive dose.
Iron is essential for making hemoglobin, the protein in red blood cells that carries oxygen to other cells. During pregnancy, the amount of blood in your body increases and you need more iron to make more hemoglobin for all that additional blood. You also need extra iron for your growing baby and placenta.
Unfortunately, most women start pregnancy without sufficient stores of iron to meet their body's increased demands, particularly in the second and third trimesters. This being your third pregnancy and with previous history of anemia you are at high risk of suffering from anemia again. Iron is stored in the body as ferritin. If you have low ferritin levels , it means your iron reserves are low. Hence despite a normal serum iron level at present with the growing demands of your pregnancy, without an additional supplementation you will start showing signs of iron deficiency anemia.
You do seem to be showing signs of iron deficiency. It would be advisable to get your hemoglobin levels checked. If you are anemic additional tests will be advised such as a complete iron study, serum B12 levels etc. to investigate the cause of anemia.

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