Pernicious Anaemia Society

Do I have B12 deficiency? Here are my present lab results :

Methylmalonic acid-Urine 0.90 mg/L

Creatinine. 0.38 g-l

Methylmalonic acid/creatinine *2.37 mg/g. <2.0


Result from Referral Laboratory. ID (900)

Transcribed as per report. ( Methylmalonic figures are in red)

Homocysteine. 15.10. umol/L (also in red)

Desirable level up to 10umol/L

>15umol/L may indicate increase risk of cardiovascular disease.

Elevated values may occur if correct sample collection procedures are not followed.

EDTAor serum samples separated within 1hr is recommended


MCV 88.8. fL 80-90

MCH31.1. pg 26.0 -33.5

MCHC. 35.0. g/dL. 30-35

Blood samples were taken in the doctor surgery I don't know if serum samples were

Separated within 1Hr.

I have numbness on most of my back more on the Lt also numbness Lt back head and neck at times, Lt outside leg intermittent tingling crawling on my scalp and face some times soles of my feet .

I am also hypothyroid replacement not optimal yet ,plus have hypoadrenalism.

My balance is frequently poor I sway and stagger frequently.

Blood samples taken by private doctor,my NHS GP refused to do a referral letter to Guys St Thomas said my Serum B12 was fine at 494,ferritin 49, folate 7.2 April 2013.

I look very pale,gastro/intestinal function very poor IBS also appendix removed many years ago.

I would be grateful for guidance anything really,should I insist the private doctor organised an Intrisic Factor ,and Pariatel cells antibodies tests. I wonder if he failed to separate the serum samples within the hour of taking the blood for Homocysteine

Can he do the other tests correctly?

Please what shall I do,I feel very unwell

6 Replies

Do you have the range for uMMA?


Sorry I've realised you've copied them exactly, so it seems it's the ratio that's important, and that plus homocysteine is elevated. Given your symptoms I would think that you need treatment - B12 injections plus folate and a B Complex. Has the private doc got any recommendations? Can he write to your GP so you can get treatment on the NHS? The new BCSH guidelines might help if you want to approach the doc directly.


Hampster1 thank you for your reply, I understand the homocysteine being elevated,but don't understand the UMMA result, so it is the ratio between the Methylmalonic acid and the creatinine that is important you say,does that mean that it is above the normal level ?.the doc seems to think it was slightly up,but he concentrated on the homocysteine and has prescribed a supplement called the H Factors which is supposed to lower the homocysteine he said it had some B12 in it.

Please what are the new BCHS guidelines how can I access them. What is the H Factors supplement? Of course I would be happier to start on Methylcobalamine or even B12 injections.


Just looking into this a bit more, this is the uMMA test website:

"The test measures methylmalonic acid (MMA) by selected ion monitoring isotope dilution gas chromatography mass spectrometry (GC/MS) in a random spot urine specimen. The MMA value is normalized to urine creatinine to correct for urine dilution. The urinary MMA/creatinine ratio (uMMA) test is more accurate than the blood test as it indicates tissue/cellular B12 deficiency."

So it is the ratio that is important, because that's correcting for urine dilution.

"What are normal MMA levels?

Normal MMA is < 3.8 micrograms of MMA per milligram of creatinine (< 3.6 micromole MMA per millimole of creatinine)."

This however does not tie in with your lab range, perhaps the units used are slightly different? I really don't know. Perhaps your private doc is not focusing on it because you are only slightly above the range? I would be really tempted to call the actual lab who ran the test, and ask them did they consider your result B12 deficient.

I hadn't heard of H Factors so looked it up, is it this one?

I'm surprised he's suggesting one with folic acid rather than methylfolate, and I'm surprised he's not asking you to take separate B12, either sublingual or injectable. I personally would also prefer a B-complex with all 8 B vitamins (they work together) rather than just half of them. The 2 good ones I know with active ingredients are Pure Encapsulations B Complex Plus and Thorne Research Basic B. I'm sure there are others as well.

The British Committee for Standards in Haematology (BCSH) guidelines are here:

If you look at Algorithm 1 a normal serum B12, but with clinical symptoms of deficiency, takes you down the right hand side of the flow chart, and suggests that you should have the anti-IF antibody test plus MMA, homocysteine or active B12 tests, plus treatment. And in the final box:

"(i) Elevated MMA, tHcy, or reduced HoloTC

(ii) or definite objective clinical response

lifelong treatment asPA (anti- intrinsic factor antibody positive) or AbNegPA (anti-intrinsic factor antibody negative) pernicious anaemia"

I would discuss this with your private doc as he may not have seen these guidelines, they are new.

H x

1 like

H,thank you so much for your detailed and extensive reply to my questions,for the web sites and explaining so clearly how the urinaryMMA/creatinine is measured,why it is more accurate than the blood test as it indicates tissue/cellularB12 deficiency and the importance of ratio between the two.

As you suggested I called the lab (TDL) were they ran the test to ask if my results point to a deficiency of B12,sadly the lab technician said he is not qualified to comment and referred me back to the doc that requested the tests.

When my lab tests results were discussed at the surgery 2 weeks ago the doc seemed evasive/hesitant about the uMMA/creatinine results,but decisive about the homocysteine which is clearly high.

Re the HFactors he prescribed thanks for looking that up I don't know if it is the Hihger

Nature one as I am still waiting to receive it (ordered on 30th May and having to chase it up). It's an up hill struggle!

Having read your comment that you are surprised the doc is suggesting Folic acid rather than Methyl Folate and not choosing to prescribe B12 by injection or sublingual together with a B complex supplement I don't feel so sure about his advice.

Thanks for giving me the names of two good B complex supplements.

I have looked at the BCSH guidelines very useful to refer to,will read them again when my brain fog is less dense. Will point them out to the doc as you say they are new.

Apologies for my late response to your very helpful info,bad day yesterday.

You have been a great help, thank you.


I should just say I take folic acid to great effect, couldn't be without it, but it was just my thought that high homocysteine whilst having normal levels of B12 and folate can be a pointer towards problems with methylation / MTHFR genetic defects. And sometimes in these cases people need the more active forms of B12 and folate. Ask your private doc about MTHFR and pin him down a bit more about the uMMA result, you're paying for his advice after all. A good website is (definitely don't look at this on a brain fog day)!!!

H x


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