Hematologist

[Ktululady]

I have read that if it is not clear what is causing B12 deficiency symptoms it is best to see a hematologist. What would they do exactly? If my doctor agrees to give me injections is there any need to see a hematologist? Do they do other tests to determine what the cause is?

[fbirder]

This is what the NICE guidelines cks.nice.org.uk/anaemia-b12... say about referrals...

"Seek urgent advice from a haematologist if the person has neurological symptoms, or is pregnant.

Refer to a haematologist if the cause of vitamin B12 or folate deficiency is uncertain following investigations, or the suspected cause is haematological malignancy (urgently refer) or other blood disorder."

Your GP should already have investigated possible causes...

"Determine whether there is an underlying cause for the serum vitamin B12 deficiency (for example pernicious anaemia), by checking for serum anti-intrinsic factor antibodies.

Note that testing for anti-intrinsic factor antibodies is recommended in people with strong clinical features of B12 deficiency, such as megaloblastic anaemia or subacute combined degeneration of the cord, despite a normal vitamin B12 level. For more information, see the section on Interpreting results of investigations.

Checking for gastric anti-parietal cell antibodies is no longer recommended to diagnose pernicious anaemia."

[Frodo]

As a caution, I've read a number of posts on here where the haematologist has said that the patient does not need injections because the B12 blood level is within normal range, despite neurological and other symptoms.

[fbirder in reply to Frodo]

In which case you get a stonemason to engrave the NICE guidelines on a nice bit of granite (cheaper than marble, but just as effective) and beat the haematologist over the head with it until they admit that they're wrong.

Or you could just hand them a paper copy and say "I thought you guys were supposed to follow the NICE guidelines. At least that's what my journalist friend said".