Pernicious Anaemia Society
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Calling hamster

Hi sometime ago someone told me to look at replies by hamster because they were so knowledgable I found a link that they posted which showed how and when doctors are supposed to treat I can't find it now

The reason I'm asking is my mum has just been told by doctor her b12 is normal she did as I asked and got figures but dint get ranges it was 264 she is 71 but had been getting steadily worse over last couple of years her uncle died of pa and she has frequent urination tingling in limbs and she gets really muggled forget fully she has eye problems sleep and joint problems

2 Replies

Haven't seen hamster post for a while.

I think the lower limit of the range should go up as you get older but can't remember the details.

I think that before the recent migration on Health Unlocked you used to be able to see people's activity as well as their posts but now you only seem to see the posts.

NICE guidelines on treatment can be found here

however, reading through some of the diagnosis there is a lot that is left out.

More useful might be the BCSH guidelines on cobalamin and folate deficiency

Key recommendations in relation to B12 are

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 currentlylimited.

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

I don't have a link for the BNF - though there is one in the document and it looks like you have to be registered.

Hope this helps a bit.

1 like

Thanks for that very helpful


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