blood test results - help with interpretation please!

[shipscat]

I visited my GP last week to request more frequent B12 jabs as I was still presenting a lot of symptoms a month after my 12 week jab.

This was the result: range in brackets

Serum ferritin 115 (12.00-250.00)

Serum folate 8.3 (2.00-18.80)

Serum vitamin B12 >1500 (150-1000)

Serum TSH 2.8 (0.3-4.5) -i'm on throxine

Rheumatoid factor <5.0 (0.00-14.00)

Full blood count (note next to result says tell patient acceptable no further action)

Haemaglobin estimation 129 (115-165)

total white cell count 6.3 (4.0-11.0)

MCV 97.6 (82.00-100)

*Haematocrit 0.366 (0,37-0.47)- a bit low

*Red blood cell count 3.75 (3.80-5.80)- a bit low

*Mean corpos. haemoglobin (MCH) 34.5 (27-32) -a bit high

Those were the main results. The ones that concerned me the most I have put a star beside. The B12 result was as I would expect 4 weeks after a jab and I also take sublingual tablets and drops.

Looking at the starred result and having done some of my own research. I think I may have macrocytic anemia which I understand is related to a B12 deficiency.

My main symptoms are tiredness, aching and stiff joints, palpitations (I had an ECG which confirmed this), pins and needles, earache and tinnitus.

As the doctor has said no further action required I would like some advice form anyone with B12 experience and maybe some medical knowledge as to what to do next. I am going to try adding a bit more iron into my diet as that may help but i'm wary of iron supplements as they can often do more harm than good.

Thank you all once again.

[Gambit62 Administrator]

Macrocytosis is one of the symptoms of B12 - caused by not having enough available to manage the process that produces B12 properly. It will take a few months for this to correct once you do have enough B12 because the body balances the production of red blood cells to replace cells that die.

It is most likely other effects of B12 deficiency that will be causing the other symptoms you mention - not the macrocytic anaemia - but whilst you have been deficient those systems won't have been functioning properly so it will take a while for everything to repair.

Your folate isn't brilliant - would recommend trying to keep it towards the upper end of the range - easy for it to become depleted when you start B12 treatment as you use it up in processing and using all the B12.

[shipscat in reply to Gambit62]

Thank you, I'm just trying to make sense of the results. My folate level was 7.2 before I started having the B12 jabs so it has risen slightly which I hope is a good sign. What dose of folic acid do others take?

Is my now high level of B12 a good sign that it is beginning to work? I have about 6 weeks to wait until the next injection. I now know I can't have them more frequently. I've only been on B12 treatment since January so I guess I'll have to be patient as I suppose everyone responds differently to the treatment. My original B12 was only 106 so that may explain why it is taking so long.

[Gambit62 Administrator in reply to shipscat]

you can get 400mcg tablets at healthfood stores and chemists - generally its best to get folate (and any other nutrients) from food - so plenty of fresh fruit and veg may well be in order.

levels in the serum test don't really mean anything unless they are low. High levels should not be used as an excuse for withdrawing treatment though they frequently are. Carry on with the supplementation as you feel you need it.

The three months is a load of rubbish with no scientific backing - if you have neuro symptoms then it should be every 2 months so might be worth going back to the doctor on that.

Sounds like you were deficient for quite a while for levels to have got that low so quite a bit of repair that needs to be done - best thing to do is list all the symptoms you had and then note what is improving ... and if things start to slide before your next shot you certainly wouldn't be abnormal.

[shipscat]

What is the best information to take along to my GP to convince her that the paraesthesia (pins and needles) is a neurological symptom of a B12 deficiency? I woke several times last night with the tingling in my hands and I also had itchy feet which went away for a while but have come back. The tingling has also increased in frequency. It went away after my loading doses but has now come back worse.

I need to convince her that although my latest blood test shows a high level of B12 serum it may not be addressing all the symptoms.

Thanks again

[fbirder in reply to shipscat]

Download my summary document - frankhollis.com/temp/Summar... - and from inside there download the BMJ document. At the back of that is a diagram showing the symptoms of B12 deficiency - including paresthesia (your pins and needles)

If she still refuses to be convinced ask to be referred to a neurologist, who can test your paraesthesia and try to determine a cause.

[shipscat]

Thank you fbirder, I have downloaded a copy of the your summary document and BMJ document and will take it with me when I see the GP, just in case.

I'll let you know how I get on.