Hi my b12 serum is 264pmol/l gp says normal..is this low??

[niceguy]

[Hidden]

Hi Niceguy,

The serum B12 test is not a very accurate test for determining a B12 def, your levels can fall in the so called grey area so it depends on how you are feeling , and if not well, evidence showing problems associated with B12 def, then further tests could show a B12 def at tissue level although not in serum. Further tests could be HoloTC (Active B12 test) and or depending on that result MMA (serum methylmalonic acid) and or homocysteine to rule out a functional B12 deficiency.

This may help you, see:

ncbi.nlm.nih.gov/pubmed/191...

Pract Neurol. 2009 Feb;9(1):37-41. doi: 10.1136/jnnp.2008.161968.

Functional vitamin B12 deficiency.

Turner MR1, Talbot K.

Abstract

We describe a case of functional vitamin B12 deficiency where the repeated measurement of a serum B12 level within the normal range led to delay in the diagnosis of subacute combined degeneration of the spinal cord, and possibly permanent neurological damage as a result. Failure of intracellular transport of B12 by transcobalamin-2 can lead to functional B12 deficiency but with apparently normal serum levels, and is suggested by raised levels of either serum methylmalonic acid or homocysteine, associated with low levels of transcobalamin-2. Such patients may respond to repeated high-dose injections of B12

And:

bcshguidelines.com/document...

•Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders, British Committee for Standards in Haematology (2014)

Summary of key recommendations

 The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status since there is no ‘gold standard’ test to define deficiency.

 Serum cobalamin remains the first line test currently, with additional second line plasma methylmalonic acid to help clarify uncertainties of underlying biochemical/functional deficiencies. Serum holotranscobalamin has the potential as a first line test, but an indeterminate ‘grey area’ may still exist. Plasma homocysteine may be helpful as a second line test, but is less specific than methylmalonic acid. The availability of these second-line tests is currently limited.

 Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues, and local reference ranges should be established.

 In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment.

 Treatment of cobalamin deficiency is recommended in line with the British National Formulary. Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue.

For Active B12 test in UK see:

viapath.co.uk/our-tests/vit...

contact from the website:

Nutristasis Unit at St Thomas' St Thomas' Hospital North Wing - 4th Floor Westminster Bridge Road London SE1 7EH Telephone:[phone] / 89543 -

active-b12.com/home

active-b12.com/content/acti...

I hope this helps,

Marre.

[treacletart33 in reply to Hidden]

Hi Marre, thank you for your reply about vitB12 and alcohol. Just reading your above post on the tests that can be done... I have already been diagnosed with pernicious anaemia and am going to see my doctor next week to see if I can have the dosage increased, would any of the above tests help to gain evidence for an argument to have either more frequent injections or a higher dosage? My neurological symptoms and physical tiredness are increasing a lot over the past 6 months. I currently have the vitB12 injections once every 2 months. Thanks for your help.

[Hidden]

Hi Treacletart,

It is not terribly usefull to have the above mentioned test once you are on B12 treatment, the tests are unlikely to show a B12 deficiency, once on treatment, unless your serum B12 currently is still on the low side, the so called grey area.

This topic on the old forum may help you find what you could give your GP to help convince him/ her to try more frequent B12 jabs, see:

surreywebsitedesign.com/pre...

I wish you luck! Some GPs are open to trying a regime of B12 treatment that suits the individual, but many will stick to guidance given in BNF etc.

Marre.