Pernicious Anaemia Society
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Please help me with understanding blood test results!

Hello, I would really appreciate some help understanding my blood results. Bit of history, I have always had low ferritin since I was a teen (now age 35), my doctor when I was 16 had me on iron supplements which I stopped taking due to them messing my stomach up. Around the same time I was told I had chronic fatigue syndrome, and was very ill for a year or so. In my twenties things went up and down health wise, always having stomach and energy problems. A few years ago I started getting neurological problems, mostly chronic dizziness, headaches, pins and needles, tinnitus, anxiety and depression, insomnia, numbness and weakness. I had my b12 levels tested and they were I think around 160, which was in normal range (range began at 150 I think) but my doc at the time decided I should try injections. Seems like she didn't really understand how it works though as she just gave me one and says if I didn't improve then my symptoms weren't due to b12. They didn't improve and have generally got worse over the last few years. I started passing out as well recently so went back to the GP and asked to have copies of my last bloods, which she had told me were normal and that i was "fine". My ferritin was 14 and b12 199. Within range but still low, so i thought I should probably supplement, but I am confused as to what I should take as I also had a full iron profile done recently and although my ferritin was again at 14 my serum iron was quite high and so was transferrin saturation which I've read indicates iron overload. I was fasting for 12hours before the blood test and had been off any supplements for a few weeks. I know that there are connections between iron and b12 and folate but I can't really get my head around it so not sure what I should be taking or how much. Is there any reason anyone knows that would give low ferritin and high iron? Can low b12 levels affect ferritin or are the two completely separate? I don't want to take loads of iron if it's going to do harm. All the results on my complete blood count were within range too, so does that mean the low b12 and ferritin aren't effecting me and I'm barking up the wrong tree? My doctor is not interested in it at all, as long as things are in range she thinks it's fine. I'm just so sick of being sick and if there's a chance I can improve symptoms I would really like to give it a go. I have copied all my results below, if that helps. Sorry for the long post and thanks in advance to anyone who can help me understand whats going on and what I should do next!

B12 199 ng/l (150-650)

serum folate 8.3 ng/ml (3.1-20)

serum ferritin 14 ng/ml (11-307)

Iron 27.9 umol/L (5.8- 34.5)

TIBC 63 umol/L (41.0-77)

UIBC 35.4 umol/L (24.2-70.1)

Transferin saturation 44.4%

WBC - 8.8 (4.4-11.3)

RBC - 4.44 (3.9-5.3)

HB - 13.0 (11.7-15.9)

HCT - 0.383 (0.35-0.46)

MCV - 86.3 (80-96)

MCH - 28.7 (27-33)

MCHC - 32.3 (32-36)

11 Replies

I would ask the doc for four things =

An MMA test. Methylmalonic acid is a chemical used up in one of the reactions facilitated by B12. Low B12 means the MMA builds up. High MMA is a good indicator of a B12 deficiency.

A trial of proper treatment with B12. Three injections a week followed, after three weeks, by a review of symptoms. If they've improved, and they're still improving, keep up with three a week until the improvement stops.

A full blood test for thyroid function. Hypothyroidism can have similar symptoms to B12 deficiency.

An HbA1c test for diabetes. Again, some symptoms are shared.

In the meantime I would start taking one a day of Solgar's Gentle Iron. It's a fairly low dose, and is much kinder to the guts that iron sulfate (the cheap stuff that docs like to prescribe).

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Thanks for you help! I asked before about getting MMA test but doc said it wasnt available (dunno if thats true!) and I asked at a private clinic and they couldnt do it either. I live in Ireland so maybe the labs are different here? Would you know of anywhere that would send me tests to do at home? I had a look online but no dice. I had my thyroid tested and results were TSH 1.62 (0.4-3.8) and Free T4 15.3 (12-22), so all looks fine there. I just cant get my head around the high iron and low ferritin, its so confusing


Oh and I was taking the solgar gentle iron for a bit and it was fine on my tummy, but not sure if I should be taking it now. Its probably not strong enough to do any damage though eh?


As Fbirder says, there's a possibility you may also have thyroid problems, in which case your ferritin is far too low to allow healthy thyroid function. Over on the TUK forum the recommendation is that 70 ng/ml is the lowest level you should aim for. You don't want ferritin too high either, but don't worry about that just now.

Ask your GP for a FULL thyroid function panel, not just the TSH, which is neither use nor ornament by itself. Get the blood drawn as early in the morning as you can, on an empty stomach (you can have water). You need:


Free T4

Free T3

Thyroid Peroxidase (TPO) antibodies

Thyroglobulin (TG) antibodies.

If your GP refuses to do all of these, you will have to test privately. Members of the Thyroid UK forum, another community here on HU, usually recommend the Blue Horizon lab. I haven't used BH myself, but Hillman is currently considering them.


Thank you! I have had TSH and free T4 done - they are TSH 1.62 (0.4-3.8) and Free T4 15.3 (12-22), so all looks fine there. Do you still think it's worth getting the other thyroid tests done? I know my doc will refuse and I'm so strapped for cash I dont want to get them done privately unless it seems necessary. Thanks again for your input, really appreciated :)


Hashimotos - auto-immune thyroid illness - is the most common thyroid condition throughout the world. So without the anti-bodies being tested you will never know.

I was diagnosed with Hashimotos back in 2005 - the TSH - FT4 - FT3 were all in range however the anti-bodies were sky high. I am fortunate to live in Crete where they still look at the whole situation - and so my Thyroid journey began and I received treatment. The comment from my GP was - you need treatment to support your thyroid whilst under attack from the anti-bodies,

Well it made sense to me :-)

Your FT4 is not optimal - so it is possible your thyroid is beginning to struggle to produce the storage hormone T4. That has to convert into the ACTIVE hormone T3 and it can only do that well with good levels of VitD - B12 - Folate and Ferritin. The FT3 test is the most important test and tells you so much more about what is really going on with the thyroid hormones.

Blue Horizon does Finger Prick tests at home - results within a couple of days

Hope you soon find some answers ....


Thanks so much! Very interesting. The information and help I've been given from the kind folks on this website is so much more comprehensive than my GP! What did we do before the internet? :/ I will look into getting the blue horizon test done.

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What Marz said...:-)

Do bear in mind that you need FT4 high in range to give you a sufficient reservoir to convert to FT3. The good people over on TUK usually recommend FT4 in the top quarter of the range, and FT3 in the upper third. Even so, as Marz says, you can have thyroid hormones in middle-upper range and still suffer symptoms if your antibodies are high. Best to get it all tested if you possibly can. I appreciate this is difficult to do when you're strapped for cash. I believe BH have an offer on thyroid testing during October.


Have a read of this. Your ferritin is extremely low, and you should find you feel less tired if you supplement.

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Hi, thanks yeah I know about low ferritin but my serum iron and transferin saturation are at the high end of normal, so am wary about supplementing. Too much iron in the blood can also be harmful. It's like there's plentry of iron circulating but for some reason it's not getting stored in my tissue. I'd love to know why!


Too much iron can be harmful, but you are within range, and ferritin is simply a store for iron, iron in the cupboard. As people move towards anaemis, for example, blood iron will be normal but ferritin low.

You could try some supplementation and see if you feel better..


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