Hello. My name is Tiffany. I thought I had iron-deficiency anemia, some other kind of anemia, and/or P.O.T.S. I have very specific symptoms of iron-defiency anemia (which I ve listed at the end of this message). When my blood flow is bad, my heart beats harder and I breathe harder. The worse my blood flow is, the worse those symptoms get. The most peculiar thing is how my body reacts to taking iron. I started taking one 65-mg iron supplement per day back in December of 2022 (roughly half a supplement before bed at night and half a supplement before I get up in the morning, so about 32.5 mg at once). Within seconds of taking, I feel chills in my arms. Quickly following that, my heart starts beating increasingly harder and I breathe increasingly harder. I figured it had to do with poor blood flow to my arms and keep them warm under the covers. This keeps the symptoms from escalating too much and helps to relieve them pretty quickly. Then before I know it, I feel so much better than I did before taking the iron. I feel more relaxed, my blood flow feels better, and a cut on my hand would throb when it was numb before. The first time I took iron, I felt so much drastically better. I still notice a big difference, but nothing like that first time. This relief is always pretty short-lived, however, and I feel almost as poorly as I usually do after maybe 30 minutes or an hour of taking the iron. However, after weeks or months of taking iron every day, I noticed other improvements. The most notable one is I finally feel period pain again, which disappeared with the appearance of my symptoms. I also notice I bleed more during my period, and I ve even noticed improved blood flow to my eye muscles and better eyesight. I also noticed that taking 500mg of vitamin C with cereal rich in iron helps my symptoms quite significantly, whereas I feel much weaker if I take it with cereal low in iron. However, I used the Request a Test website to have a blood test done by Labcorp back in June of 2023, and Request a Test gave me my results. My RBC, hemoglobin, vitamin B12, and iron levels are normal (my ferritin is slightly high at 173, probably due to taking iron supplements). What does this mean? Is it possible I could have anemia or iron deficiency with normal blood test results? Could a bone marrow aspiration sample lack iron if my blood test results are normal? And if so, how would I treat that? If my iron levels in my blood are normal after taking 65mg of iron per day for 6 months, would that mean they were low before? Is it possible that I just have P.O.T.S. despite the reaction I have to taking iron? Or does that indicate another condition? I m very confused. Please help me figure out what s wrong and what to do from here. Please let me know if you need to see more of my results. I ve listed some of my symptoms and some of my test results here in more detail: Symptoms I have experienced at times include Fatigue Weakness Dizziness Lightheadedness Shortness of breath Quicker, more rapid breathing Heart beating harder Chest pain Poor blood flow Heat intolerance Difficulty regulating temperature Lack of sweating Chills Hot head Flushed cheeks Cold hands and feet Purple hands and feet Numbness Peeling finger nails Purple nail beds Slightly concave/spoon nails Headaches Tense muscles in the neck, shoulders, and tongue (likely due to poor blood flow) Easy bruising on neck Brain fog Difficulty concentrating Difficulty losing weight In a nutshell, the things that make my symptoms worse are excessive heat and not maintaining enough blood flow. Things that make my symptoms worse (in more detail) include Getting too hot Getting too cold Lack of sleep Sitting for long periods of time Standing for long periods of time Going too long without cold water Going too long without eating Not eating enough of certain nutrients (mainly iron and niacin) Intense exercise? Exercising without maintaining a steady temperature The wrong kinds of exercises (like those involving jumping or heavy lifting) Sitting or standing in a posture that reduces blood flow, rushes blood flow to the head, or reduces lung capacity (like hunching over) What helps with the symptoms is essentially the opposite of what worsens them: Staying cool Keeping my blood flowing Ceiling fan Open window with cool, fresh air and breeze (preferably outdoor temperatures in the 50s or lower 60s) Cooler temperatures that allow me to wear heavier clothing that covers my arms and legs (being cool enough to wear a sweatshirt vs. warm enough to need shorts) Adequate amount of and quality sleep Ice water Cool, wet rags Exercises like walking or sitting while pedaling my legs in the air (since I don t have a recumbent exercise bike) Eating certain kinds of foods rich in iron, niacin, and/or resveratrol (like Great Value Bran Flakes cereal, General Mills Total, Jif peanut butter, grapes, and apples) Good posture that promotes blood flow and breathing (like sitting up straight) Some test results: RBC: 4.30 Hemoglobin: 14.4 Hematocrit: 42.2 TIBC: 306 UIBC: 169 Iron: 137 Iron Saturation: 45 Ferritin: 173 Transferrin: 257 Reticulocyte Count: 1.7 Vitamin B12: 948 Folate: 20.0