I suffer from a continuous reduction of hemoglobin?

My problem can be easily described. I suffer from a continuous reduction of hemoglobin. Every day I have to take iron supplement to retain my hemoglobin levels in normal range.
I give you an example of my condition. Let’s say I take an iron supplement for a year, the blood analysis confirms hemoglobin level at 146 g / l. Subsequently I cease to take an iron supplement. Two months later hemoglobin level falls to 97 g / l. I could give you several similar examples during previous 6 years.
Then I always start to take iron supplement again and my hemoglobin levels come back to the normal. If I take iron every day, hemoglobin levels remain within normal limits. Basically, I must constantly take the iron supplements.
I believe that the absorption of iron by my guts should be fine though. Hematologist said that when my hemoglobin levels are increased after taking iron supplements, absorption should be fine. Also, when I took iron tablet at night on an empty stomach, my GP confirmed after the blood analysis that I had elevated levels of serum iron (that was also independently confirmed by another doctor a year later).

I do not suffer from celiac disease. I should not suffer from an increased destruction of red blood cells, bilirubin levels are normal. I am not a vegetarian. I have no intestinal parasites. The amount of vitamin B12 and other blood parameters are in normal ranges.
These problems started about 6 years ago, before that I did not need to constantly take iron supplements.

I would like to ask you few questions:
1. May I have some form of iron malabsorption considering the fact that my body is able to absorb sufficient amounts of iron from the supplements but not from normal diet?
Note .: My sibling eats almost the same food as I but his hemoglobin levels are absolutely all right, without need of taking iron supplements.

2. What various conditions or illnesses should I have?

3. What can cause so massive decreasing of hemoglobin levels? Where do I lose it, if I do not bleed?

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Ahmed Fawzy
11:30 pm

In my opinion you do not have malabsorbtion, but you have mass losing of your iron stores or inability to transport iron
Possibilities are
1 long term use of anti inflammatory drugd
2 hookwarm (need a stool test )
3 chronic kidney disease
4 inflamatory disease

Also check you ferritin(store) and Transferrin (transport ) levels
Which can help you identify if there is a kidney or liver problem
Also a condition called atransferrinemia where you have a problem producing transferrin

Hope i was of help
Good Luck

Ayman Darrag
11:35 pm

In my opinion this is type of hemolytic anaemia which has a bunch of causes from mild infections to severe tumors which I do not think you have them.
You need to get these tests to figure out the cause.
liver function tests
reticulocyte count
Serum ferritin.
Thanks .

Masr Fawzy
5:15 am

Could you give me a detailed history about your menses ma’am please
How many pads are you changing a day
Do u consider it heavy or not..

Cause heavy menses could be a simple hidden cause for your situation

Also u may have a trouble with thr inactive form of iron in diet, and your body can not convert the inactive form into active form., and your body is only responding. To yhe active form in iron supplements

Best regards

8:16 am

this seems to be a multisystem disorder related to the hormonal balance in the body.
your body is unable to store the generated hemoglobin and gets destroyed easily.
a bone marrow study will confirm and rule out other causes like hemolytic anemia,spherocytosis etc.