Test Results

[eddi_c]

I would be grateful for your thoughts. These are the results of a blood Dr asked for following my request for an early jab. I had been taking Jarrows Methylfolate 5000 prior to the test and the blood was drawn about 2 months after a jab.

Once again, I have been experiencing burning feet/legs, tingling in hands and aches and pains in my arms, extreme tiredness and am currently laid up with chronic back pain. I have made appointment to see Dr next week to request injections bi monthly but the fact that the report states "b12 deficiency recurred but not due b12" I really don't want to shoot myself in the foot so any help/advice really would be appreciated.

Ferritin 32 ng/ml 12-280

Folate >24.4 ug/l 3.1-199

B12 >1500 ng/l 150-900 (this time last year when first diagnosed 137)

Lymphocytes 3.7 44% 0.9-3.2

Many thanks

[fbirder]

Your doctor should follow the recommendations from the British Committee for Standards in Haematology - bcshguidelines.com/document...

Here's part of the summary.

"In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

[eddi_c in reply to fbirder]

Thank you fbirder... i will bring this to the Dr's attention. I am hoping that he will be open to any information as I understand that there has been some discussion at the surgery around the volume of patients presenting with B12 deficiency.

[Gambit62 Administrator]

Sorry to hear that you are one of the many who doesn't cope on the standard rations.

The NICE guidelines actually recommend referral to a haemotologist if symptoms return before next injection is due

cks.nice.org.uk/anaemia-b12...

The serum B12 results after supplementation - particularly so shortly after the jab - don't really mean anything if you they are high (more significant if they are low as it shows your kidneys are very good at removing excess B12 from the blood so you obviously need more frequent jabs to counter act that).

Serum B12 doesn't tell your doctor anything about how well you are converting hydroxo to active B12 forms ... and no blood test is really going to show what is happening at the cell level - though markers like MMA and homocysteine will give a guide to whether metabolism is operating fully efficiently.

As you have neuro symptoms standard treatment in UK would be jabs every 2 months

cks.nice.org.uk/anaemia-b12...

also, the loading regime is slightly different at 3xper week until symptoms stop improving ... though if your GP is one of the many who hasn't grasped the severe limitations of serum test then it may be very difficult to get them to consider redoing the loading shots per that regime.

Note: BCSH recommendation is review every 3 weeks.

Have you kept or could you construct a dairy of symptoms that shows time-scales on which problems start to come back?

[eddi_c in reply to Gambit62]

Thank you Gambit. I really don't know where I'd be without all the helpful and knowledgeable people on here. I can't quite grasp the ferritin/folate thing as I have it in my head they are both to do with iron. The test result for folate above should read Folate >24.4 ug/l 3.1-19.9 so it would seem high but the result for ferritin doesn't seem particularly high to me. I am confused as to what I should be supplementing with to correct that.

[Gambit62 Administrator in reply to eddi_c]

Ferritin is a protein that enables you to store iron. Without iron you can't produce haemoglobin and without haemoglobin your blood can't transport the oxygen that cells need from your lungs to cells. This is called iron deficient anaemia.

B12 and folate (B9) are both vitamins. Different cells in the body use them for different things - one of the uses is ensuring healthy cell production. One thing that happens if they aren't working properly is that your blood cells become deformed. B12 generally leads to the cells being larger and more rounded. The change in shape means that they are less efficient at absorbing oxygen (surface area much smaller in relation to volume) so your blood gets less efficient at transporting iron from the lungs to cells where it is needed. However, this type of anaemia isn't necessarily the first problem to manifest when B12 is low. B12 and folate are also used to maintain the insulating layer around nerve cells - hence the neuro problems. They also work together to deal process some waste products that build up, eg in dealing with fats. If the products aren't processed back into something useful then a lining builds up in blood vessels leading to coronary problems etc.

this may be of use in trying to get your head around things

nhs.uk/Conditions/Anaemia-i...

[eddi_c in reply to Gambit62]

That makes sense. Now you have explained it is a protein that enables iron to be stored I understand! Going to read link. What a learning curve all this is. Thanks again