Pernicious Anaemia Society
15,526 members10,922 posts

Active B12 Test


I recently posted my Serum B12 and Folate results and some people on the Thyroid Uk site commented that my B12 should be higher, as indeed the laboratory report (I have Hashimoto's). I had an active B12 result that I am posting below - I presume that this is an ok result but would welcome your comments. I have also posted this on the Thyroid Uk site.

B12 244 pmol/L range 142-725

Folate 1183 nmol/L range 158-1099

Intrinsic Factor Antibodies Negative

Active B12 63 pmol/L range 25.1 - 165.0

Many thanks in advance

12 Replies


Your serum and active B12 results are all just still bordering in the grey area, it could be good to have MMA tested. Unfortunately quite expensive, or wait 3-6 months (with out supplementing anything that contains B12 etc) and see if B12 has sunk.

Your serum folate is to high, re:"Folate 1183 nmol/L range 158-1099", are you supplementing? Or eating a lot folate rich foods, or cereal, marmite etc? If so stop supplementing and see what happens in 3-6 months is all I can suggest, although testing mathylmalonic acid (MMA) analysis will be an option, see:

"Reference range: >70*; * between 25-70 referred for MMA"


I hope this helps,

Kind regards,



Thank you, I I am not supplementing at all at the moment. Is serum Methylmalonic Acid the test I need (blue horizon)?


Yes mathylmalonic acid (MMA). Its not cheap and you are border line with all other tests so its not a guaranteed result for you, sorry! Marre.


Thank you


Your serum b12 test results are low Tango2 when compared with this extract from the book, "Could it be B12?", and likely to be responsible for the neurological symptoms you have detailed before:

"we believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

But, in any case, there is no gold standard test, most being unreliable and flawed. BCSH, UKNEQAS and NICE guidelines all recommend treating the neurological symptoms, which you already have, without delay to avoid irreversible damage. The problem is, as you probably know, many GPs are ignoring or not aware of latest research and you have to be prepared to fight your corner or self treat. This link has advice on how to write to your GP:

It might also be worth pointing out to GP the summary points of latest BMJ research document:

" Summary:

* Vitamin B12 deficiency is a common but serious condition

* Clinical presentation may not be obvious thus leading to complex issues around diagnosis and treatment.

* There is no ideal test to define deficiency and therefore the clinical condition of the patient is of utmost importance."

* There is evidence that new techniques, such as measurement of holotranscobalamin and methylmalonic acid levels seem useful in more accurately defining deficiency.

* If clinical features suggest deficiency, then it is important to treat patients to avoid neurological impairment even if there may be discordance between test results and clinical features.

Severe deficiency shows evidence of bone marrow suppression, clear evidence of neurological features and risk of cardiomyopathy.

It is important to recognise that clinical features of deficiency can manifest without anaemia and also without low serum vitamin B12 levels. In these cases, treatment should still be given without delay."

Hope all goes well.


Your B12 is definitely low. If you are having deficiency symptoms, you need to seriously consider a good old medical intervention!


Thank you everyone,

I have ordered MMA as part of the PA panel from Blue Horizon and will let you know the results. I agree that I should be supplementing but think unless I have clear cut evidence my NHS GP will be dismissive.

Failing an NHS diagnosis subject to the PA panel - I have been trained by a (private) practice nurse to self IM inject as my magnesium was previously very low and I have all the kit. Should I go down this road or use sublingual supplements?

Would it be possible for someone to PM me a good source of injectable B12.

Thanks again



Good luck with the test! It will be much better if you can get a diagnosis and treatment on the NHS, so good for you to try to get it right first before you start self treating.

Injecting is far cheaper than other ways of supplementing B12.

This below listed (links) is what most people here use, and where they get their supplies, you can buy most forms of B12 in most EU countries at pharmacies with out a prescription, just not in UK and Holland. Also OTC in Australia, most of South America etc.

Injectable B12. Search for 'hydroxocobalamin' and select: B 12 depot-rotexmedica 10 amp. (10x1ml) Search for 'hydroxocobalamin' and select: B12 DEPOT ROTEXMEDICA (10x1ml) , one has to mix it with saline solution the info is on their resources page (go to bottom of page) they sell methylcobalamin but its not visible on their website, you have to contact them, they speak english :

Tel.: 089 / 613 809 58

Fax: 089 / 613 809 59

Das Telefon ist an Werktagen Montag bis Freitag von 8:00 Uhr bis 17:00 Uhr besetzt.


Syringes and sharp boxes:

I hope the above all help you,

Kind regards,



So helpful, thanks!


Hi Marre

I have ordered this:

It says it contains Folic Acid... My folate is high, is this still ok to take?


No folic acid in that, it's just hydroxocobalamin.


Ah, thanks, I was confused by the bar above.


You may also like...