Pernicious Anaemia Society
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Not felt well for over a week know had b12 injection couple of weeks ago, last week had white blood cells in urine was put on antibotics know got cough feel like cold not come out been like this a week know, had blood done my esr was 33 high crp 14.6 high,have to have urine retested and bloods done again in 2 weeks, first found out b12 defeciant in May which was 100' had loading doses had it redone in August and was 406 would have thought it would be higher after loading doses but within range,bloods done in May


White cell count 6.0 (4.0-11.0)

Rbc count 4.14 (3.8-4.8)

Mcv 94 (80-100)

Mch 30.2 (27.0-32.0)

Mchc 320 (315-350)


White cell count 5.7 (4.0-11.0)

Rbc4.0 (3.8-4.8)

Mcv95 (80-100)

Mch 30.8 (27.0-33.0)

Mchc323 (315-350)


White cell count 7.9 (4.0-11.0)

Rbc 3.93 (3.8-4.8)

mcv 95 (80-100)

Mch 31.8 (27.0-32.0)

Mchc334 (315-350)

Any help please looks like rbc going down, these ok or not, thanks for looking,

18 Replies



The main problem here is between what your doctor is thinking and what we as patients are thinking - and sometimes I think we hit a bit of a burn out on thinking what your doctor is thinking!

I can't comment on the urine situation at the moment because I would, literally, have to go away and work it all out - and it's one of those days!

Looking at the 3 different periods, 2 things strike me:

Firstly that your RBCs are falling

Secondly that your MCH is creeping up.

I stand alone in the arena of b12 deficiency in taking more notice of the MCH rather than the MCV.

I don't care if it is only slightly inflated or near the top end of normal, I get the sneaky suspicion that the MCH is a better indicator of two concommitant deficiencies than anything else.

Have you had your iron levels checked? (not ferritin, iron?)

I think the rise in MCH is a pull between a microcytic and a macrocytic anaemia. I think the macro starts to win out and that's what causes the rise.

I don't know if there is anything else going on re: your white blood cells and the infection.

The loading doses in May carried you through (or at least your blood through) to August and still maintained you in the normal range. Your doctor would have been happy with that. I don't know if you are happy or not? You might just be worried about the infection or you might have recurring b12 symptoms?


Had ferritin and folate done in May. folate was 11.0( 3.1-19.9) ferritine 86 (20-300)

Folate was done in August 10.8 (3.1-19.9) what would the iron levels come under on fbc, thanks for reply



Well, you did ask ;-)

They don't do it on the FBC, they do it separately (Oh, am I having trouble spelling this week)

If they've done ferritin and it was okay then they won't do iron. They should, but they won't.

I was rather hoping they had done it but if they had and it was low they would have treated it.

I'm sure there is a sound scientific reason for my constant suspicions about the MCH - but I don't know what they are.

What I can tell you is that my MCH was slightly elevated in every test I had done for a year - and I had a good few. It wasn't until I started taking an iron supplement (before b12 treatment) that I got, shortly after, hypersegmented neutrophils on my blood test.

Even 8 months later after getting b12 and supplementing with iron, my ferritin level was still only just above 50. And the ferritin level is stored iron, not circulating and it is an acute phase reactant (it goes up if the patient is stressed)

... and I'll just edit this to add - it's only my belief, I have no firm evidence whatsoever, but I think if I hadn't got b12 treatment when I did and continued as I was taking the iron supplement, my bloods regarding anaemia etc would have done everything they are supposed to when identifying a 'regular' b12 anaemia because the iron (microcytic anaemia) was being treated.


Thanks doctor did tell me I wasn't anemic in May and August and didn't have PA, I had part of my bowel out 12 years ago on right side think it was part of the iluem which stores b12 so thing that's why I am defenciant I had to tell doctor this cause new doctors,, my mum had PA, just feel bad at the moment


MCH is a value calculated by dividing haemoglobin by RBC and multiplying by 10 e.g. a haemoglobin level of 15 and RBC of 5 would give an MCH of 30 (15/5=3*10=30). You don't show any test results for haemoglobin but working backwards from your RBC and MCH results your haemoglobin values were 12.50, 12.32 and 12.50. As the haemoglobin values are pretty consistent it looks like the increase in MCH is due to the steady drop in RBC (4.14, 4.0, 3.93).

This link - - gives more information about the RBC test but does say that a low RBC can be due to low iron, folate or B12 (amongst other things).


Do you mean haemoglobin estimation May and october it was 125 (115-165) September it was 123. I don't understand the maths either lol, thanks


Yes. I was using g/dl (grams per decilitre) as the measurement which is how it is always expressed on my test results but your test lab obviously uses a different measurement that differs from that used by my lab by a factor of 10 so if you divide your values by 10 they are the same as mine i.e. 12.5 and 12.3(2).

Calculating the MCH is easier using the measurement used by your lab. Just divide the haemoglobin value by the RBC value e.g. 125/4.14=30.2.

All I was trying to point out is that, because it is a calculated value, MCH is affected by changes in haemoglobin or RBC or both. An increase in MCH can therefore be due to either a rise in haemoglobin or a fall in RBC or both.


Excuse me, but I've just looked at this again (and tried to get it!) and I would point out that in my earlier post I wrote;

"Firstly that your RBCs are falling

Secondly that your MCH is creeping up."

... and I just read the numbers in the blood tests....


My point is that you can't judge MCH just by looking at RBC. You have to look at what is happening with haemoglobin as well.


Fair enough. But I still say it is a push me - pull you situation between an iron and b12 deficiency that prevents it from being obvious in the other bloods.

Anyway, I like the MCH as a subtle indicator that 'something' is going wrong - and usually it gets brushed over.


If you're going to do that kind of maths on a Saturday afternoon on a day I can't even spell, I will never talk to you again.



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Calculus tomorrow afternoon.

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Hi had some more bloods done this week have had a throut infection and my esr and crp markers have been high, it said to have another test in a month to see if come down, but on the print out it say my heamatocrit says highlited low

Heamatocrit .356 (0.37-0.47)

Rbc 3.81 (3.8-4.8)

Mcv93 (80-100)

Mch 31.2 (27.0-32.0)

Mchc 334 (315-350)

What I am bothered about is since May my rbc and haematocrit has been dropping should I phone doctors back, thanks,


Hi Ozzie,

Re:"Heamatocrit .356 (0.37-0.47)"; It does look like you are ( or becoming) iron def and perhaps should have more specific blood tests to rule this out, or it would be nicer to prevent than wait to see how far you may sink, but that is what I think, not what NHS medic may think I expect.


How is iron deficiency detected?

Your doctor or healthcare provider will do blood tests to screen for iron deficiency. No single test is used to diagnose iron deficiency. The most common tests for screening are

•Hemoglobin test (a test that measures hemoglobin which is a protein in the blood that carries oxygen)

•Hematocrit test (the percentage of red blood cells in your blood by volume)

These tests show how much iron is in your body. Hemoglobin and hematocrit levels usually aren't decreased until the later stages of iron deficiency, i.e., anemia.

Sometimes other blood tests are used to confirm that anemia is due to iron deficiency. These might include

•Complete blood count (to look at the number and volume of the red blood cells)

•Serum ferritin (a measure of a stored form of iron)

•Serum iron (a measure of the iron in your blood)

•Transferrin saturation (a measure of the transported form of iron)

•Transferrin receptor (a measure of increased red blood cell production)


Some in here:

Full blood count:

"Mean cell haemoglobin (MCH) - guideline normal values: 27.0-32.0 pg. High values are found in macrocytosis and low values are seen in iron deficiency."

A blood film can also help to find out if you have more than one deficiency going on, see:

I hope this helps,

Kind regards,



Thanks phoned doctors back they tell me everthing ok not to worry about it, he said my haemaglobin is 119 and that's ok that's what they look at, so don't know what to think know not right,


You have been ill, look after your self now and see what happens with your next blood test, re:

"Not felt well for over a week know had b12 injection couple of weeks ago, last week had white blood cells in urine was put on antibotics know got cough feel like cold not come out been like this a week know, had blood done my esr was 33 high crp 14.6 high,have to have urine retested and bloods done again in 2 weeks"


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