Do I need further tests for PA?

[Molliemoo1]

I have had a number of blood tests over the last few months due to having two miscarriages. My tsh and thyroid antibodies have been high and I'm being treated privately with low dose thyroxine. 

My blue horizon results showed a low b12 level:  

B12 = 215 (deficient <140, insufficient 140 - 250, consider reducing dose >750).

So BH labs marked this result as insufficient. 

GP wanted to do her own test 2 weeks later. Results came back as:

B12 = 269 (197 - 771)

So nhs labs mark this as normal and I imagine my GP will therefore say that there is nothing to worry about. 

My question to you is, do I need to push for more tests on this? I've started taking b12 lozenge 5000 mg. My folate levels are good (high end of the normal range). We would like to start trying for a baby again next month. 

Thanks 

[wedgewood]

Yes your B12 levels are low, although many GPs will not think so!( In Germany patients with a value of 500 and below have B12 treatments) Have you been tested for P,A?(Antibodies to Intrinsic factor) Untreated P.A. Can result in difficulty getting pregnant . I remember reading in one of Martyn Hoopers books about a woman GP who had failed to have children until she found she had P.A. And was treated correctly . If you have P.A the lozenges may not help. You can also have PA without the antibodies showing up! B12 deficiency can be complicated!  Taking the lozenges will make your B12 values appear high, but the B12 may not be getting into your cells. . This is what I did, but the antibodies showed up there fore I had P.A.. 

[Gambit62 Administrator]

Are you sure that you have the correct range for the BH test - 750 sounds a bit high to be classed as deficient.

Think you probably need to get your GP to realise that diagnosing a B12 deficiency cant be done specifically from the test results - the variation between individuals where B12 is concerned is just to big and what is okay for one person can be hugely deficient for another.

This alert by UKNEQAS may be of use

ukneqas-haematinics.org.uk/...

long with the summary of the BCSH guidelines on p2 and treatment protocoals on p8

bcshguidelines.com/document...

If your GP feels that they want to do other tests rather than trialing B12 then the most obvious tests are MMA and homocysteine - homocysteine is more expensive so may not be available on NHS.  Both look at levels of waste products that will build up if B12 is in short supply - though they will also be high if folate is low.

Doing further B12 tests - which would include the active test - would mean stopping any form of supplementation - 6 months for serum but about 6 weeks for active B12 - though the active B12 test isn't generally available on the NHS.

Do you supplement folate?

High levels without supplementation can indicate a genetic problem with methylating folate to the forms actually used for key processes.  This would then affect your ability to process B12.