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Pernicious Anaemia Society
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Expected B12 levels after 6 injections?

After 6 injections and one 3 monthly injection, my B12 raised from 190 to 335. I think it is still low and I do have neurological symptoms (my left side is numb -almost paralysed), tinnitus and I can't sleep at nights. My neurological symptoms got better after the 6 injections and they returned after a month or so. When I had the 3 monthly injections, it was still not enough and the symptoms came back after a month. That is why I tried B12 patches and Feroglobin. I have a phone appointment with my GP on Friday. How much would you expect the B12 to be after the treatment? I so much fear the GP is going to say that I don't need the injections any more. In fact, I desperately need them! I also have Hashimoto and I believe I need to be on the top of the range. Is this right? Thank you!

3 Replies

Hi VickyB12 I think it is irrelevant what your B12 level is as any test result is likely to be skewed because of the injections you've had.

Your doctor must treat your neurological symptoms and not just look at his computer screen.

Treatment of cobalamin deficiency

Current clinical practice within the U.K is to treat cobalamin deficiency with hydroxocobalamin in the intramuscular form outlined in the British National Formulary, BNF,

Standard initial therapy for patients without neurological involvement is 1000 μg intramuscularly (i.m.) three times a week for two weeks.

The BNF advises that for Pernicious anaemia and other macrocytic anaemias patients presenting with neurological symptoms should receive 1000 μg i.m. on alternative days until there is no further improvement.

However, the GWG recommends a pragmatic approach in patients with neurological symptoms by reviewing the need for continuation of alternative day therapy after three weeks of treatment

Did you feel no benefit from the patches?

I suggest you list your symptoms and present it to your doctor as it's so easy to forget the most vital things when face to face. Also can you take someone with you who can vouch for your symptoms as your doctor is unlikely to pooh pooh you in front of a witness.

I wish you well


I'd be inclined to agree that the level is low so evidence that B12 is being removed quite quickly by kidneys but quite probably that the GP won't recognise this as the problem. As clivealive says it's the symptoms that really count though not the levels in your blodd and that's even truer once you have started having injections.


Hi VickyB12. I agree with Clivealive and Gambit62. Your GP should treat your symptoms, not your serum B12 results. All the guidelines state this.

The fact that your neurological symptoms are returning before your 3 monthly injections is evidence that you are not getting sufficient B12 to make and keep you well. You should be on the neurological regime (as outlined by Clivealive). Your GP may not know about this - many don't.

If your GP refuses to put you on the neurological regime, please post again and we can give you some pointers on how to deal with your GP.

About the Hashimoto's - don't know 😖. There are some very knowledgable folks on the Health Unlocked Thyroid forum so if you post your question there, I'm sure that someone will be able to advise you.

Good luck with the doctor on Friday X


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