Pernicious Anaemia Society
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Low iron?

Hey everyone, new to this site but needing some help. Diagnosed with Hpylori in March and with treatment and subsequent breathe test was found to have eradicated it. Past few week I have been feeling awful. Anxious palpitations tire easily, on lansoprazole for acid reflux. Had blood last week and results I managed to get from receptionist were....ferritin 47, vitb12 311, Folate 4.0. Told me all normal. Why do I feel like I could sleep for a week solid and so so cold all the time. Any help would be appreciated.

11 Replies


You don't give much history which would be helpful in answering your questions, but I can perhaps help a little. Your symptoms of feeling cold, tired and and profoundly sleepy can be found in several illnesses. Hypothyroidism, or low thyroid gland activity, is one. Anemia, such as iron- or B12 - deficiency is another, in which palpitations would be common depending on severity.

Was suspicion of either type of anemia what prompted the testing for H. pylori? If not, why were your lab tests done to begin with?

The presence of H. pylori along with other symptoms is suspicious for B12 deficiency/Pernicious Anemia. The proton-pump inhibitor, lansoprazole, can interfere with absorption of B12 and skew test results.

According to Mayo Clinic online, if the Folate test was run from a sample of your blood plasma, a normal range is 2 to 10 ng/mL. If the test is done on red blood cells, a normal range is 140 to 960 ng/mL. I'm thinking it was the latter and if so it is low at 40.

Again from Mayo, 11 to 307 nanograms per milliliter (standard units) or 11 to 307 micrograms per liter is normal range for Ferritin in women.

Your B12 result could be interpreted as low normal if U.S. lab reference range were used, but not sure if you're in Europe. Others here will know.

Either way, many of tests for B12 deficiency are not accurate and/or depend on additional testing. Bottom line is that British, US, and other guidelines for diagnosis and treatment of deficiency now emphasize treating a patient's symptoms not the lab numbers.

Sorry, got going and couldn't stop! I hope this helps you sort things out a bit. Also, it's important to get copies of your lab reports for your records, especially with any potentially chronic condition. If they are available online through your physician's office I would download or print them out.

Best wishes, I know you'll hear more here soon,



Thanks for reply

I am in Scotland. Have been on omoprazple 40mg a day for months on end along with bottlesof gaviscon, only been on the lansoprazole since Monday and ready getting relief! I have doc tomorrow as I am currently off work (work in a hospital) with extremely low energy and headaches! Just want to feel back to my normal self. Thanks for taking time to reply!



Your history sounds similar to my own. Could be that bit b12 is on its way down. Get a copy of your full blood count and look to see if MCV/MCH are above or below range. Then speak to your doctor again. Below might suggest iron anaemia, above could be macroscopic anaemia. This was so in my case and went onto b12 jabs. But my b12 was down to 113 by then.


Thanks for reply. I am also going to ask for my readings from when I got tested back in March to see if my numbers have fallen. I am sure I am anaemic. I bloody well feel it yet they are saying they are normal!!! Three kids, work and a house to run was a doddle a few months back! Now I just don't have the energy. This constant ringing in my ears is also very frustrating and have never experienced before!


Omeprazole and lansoprazole are PPIs and can affect the uptake of B12 in the body.

You mention acid reflux. Do the GPs think you have high stomach acid or low stomach acid? The symptoms of both high and low stomach acid are very similar but I think require different treatment.

You mention ringing in the ears(tinnitus?), lack of energy, gastro problems, palpitations, anxiety which can all be symptoms of b12 deficiency.

pernicious-anaemia-society.... 01656 769467

If you leave a phone message they will get back to you.

The PAS library section has a lot of useful info including a symptoms list.


Could It be B12 by Sally Pacholok

Pernicious Anaemia; The Forgotten disease by martyn Hooper

Living with pernicious Anaemia by Martyn Hooper

Recent documents and articles make it clear that patients who are symptomatic for B12 deficiency should be treated even if their blood results are normal range. See articles below. It is possible to have severe B12 deficiency with blood results that are in range but some GPs are unaware of this.

Google "BCSH Cobalamin and Folate Guidelines"

Have you ever had an IFA (Intrinsic factor antibody) test? This can help to diagnose PA (Pernicious Anaemia). There are other causes of B12 defic besides PA. There are other blood tests such as MMA, Homocysteine, Active B12 and a "blood smear" that can be useful in helping to diagnose a b12 defic. The results of these tests will probably be compromised if you are already taking B12 supplements. These tests are available privately if unavailable from GP.

As you are in Scotland are you aware that there is a petition about B12 before the Scottish parliament?

She's mentioned here.

Is there any chance you could still have H Pylori? I have read that it can be a very persistent infection.


On waiting list for scope as blood will all ready have anti bodies for it. Feel exactly how I was when this was diagnosed back in February. My boss at work has even told me its all in my head which doesn't make me feel all that "cared" for especially as I work for the NHS!! By Vit b12 was 311 which is within normal range but I was sure my folate was low at 4.0 but I don't know the range that comes under! I am hoping that she will give me some iron/folic acid tomorrow to see if it will help. Feel as if my head is about to explode some days!! Thanks for reply!


"Vit b12 was 311 which is within normal range"

It is possible to have severe b12 deficiency even if your blood levels are normal range. Your folate level might be borderline. In my area normal is 4 or above.

"results I managed to get from receptionist were....ferritin 47, vitb12 311, Folate 4.0. Told me all normal."

I learnt from experience not to accept being told that results were "normal" after getting paper copies and finding some results were not normal. I get copies of all my blood results as it can be useful to see trends over a year. Your surgery may charge for paper copies. The other advantage of getting copies is that the reference range is normally given.

Another way to get the reference range is to go to your local NHS website and do a search.

I talked to the PAS (Pernicious anaemia society) on more than one occasion and they were helpful and sympathetic.


I had very similar feelings to you and I was iron deficient (but not showing as anaemic in my haemoglobin), my ferritin was 13. However, on iron tablets it has significantly improved but I still have some of the same symptoms you describe and my level is up to 36 so I think you could still be feeling like that at a level of 47 and everyone is different. I have read that you need a level of 70 to grow hair. Does your hair fall out a lot? My palpitations have completely gone now with iron tabs. It could also be Vit B12 deficiency as depends on how you use it. My serum, test was a fair bit lower than yours but just within range but Dr would not treat, then I paid for the active B12 at St Thomas' and I was replete so the two don't necessarily corrolate and my probs were obviously coming from iron def. Looking back now I realise I was always worse around my period due to the blood loss - feeling faint, worse palpitations, colder feet, just wanting to get in bed all the time, tight chest, needing to take a deep breath etc...does that ring any bells?

Hope the Dr can try you on iron to see if it helps? Otherwise, some people seem to have good results buying and taking Floradix (I think spelling?) themselves from the pharmacy. Thyroid can also cause similar symptoms so ask for that to be tested and also Vitamin D too.

I second getting tests printed out as gp receptionists aren't always very helpful in relaying exact numbers and I think its good to keep them and compare over time vs. your actual symptoms.

Best of luck, hope its sorted soon.


PS. Note that if you are low iron and low B12 the MCV results might look normal (one makes your red blood cells smaller, the other larger so if you are deficient in both it can make the median 'appear' normal and mask the deficiency).


Well just back from doctors. As I thought, my iron levels are on the low side (receptionists think they are medically trained sometimes). I have to continue with my lansoprazole and started on a course of ferrous fumerate. Vit b12 range said 200-900 so I am within range at 311. Hoping the iron pills will do the trick. Thankyou to all who have offered advice. It's been very helpful :-)

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Hey all. Got a print out of results today. All seem ok.

White blood count 8.0 (4.0-11.0 u)

Red cell count 4.45 (3.80-5.80u)

Haemo 141 (115-165u)

Mean cell volume 95.3 fl (80.0-100.0 u)

MCH 31.7 (27.0-32.0 u)

Serum ferritin 47 ug/l (15-200 u)

Serum Vit b12 311 ng/l (200-900 u)

Serum folate 4.0 ug/l (3.1-20.0 u)

I can't make head nor tail of these apart from black bold letters that state Normal!

5th day of ferrous folate and the bowels are certainly working!

Have a good weekend everyone. Im on shift!!


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