blood tests

[1Cazza]

hello can anyone advise me on the most accurate blood test for B12, they did test but it came back in range and wont entertain me. i have had stomach surgery and now have issues digesting fats and other things.

[fbirder]

If you suspect you may be suffering from a B12 deficiency, yet your serum test came back in range (near the top? Bottom? Middle?) then the next step would be to have an MMA test (plus homocysteine if you can get it done). These are two of the chemicals used up in reactions mediated by B12. If there's not enough B12 in the cells then the levels of these chemicals will rise.

There are other possible causes (kidney problems, low folate levels) but they can be investigated if you get raised levels of MMA and/or hCys.

[1Cazza in reply to fbirder]

I take Vit d3, that was also tested i take a high dose, asked to be given a prescription for it as i have always had to buy it they declined as i was in range.

Vit d 117 B12 /folate 334 pg/ml (180 - 914) serum folate 9.3 (3.1 - 20.0)

I really do not understand these, GP just says in range.

[1Cazza in reply to 1Cazza]

i also remember that years ago there was blood tests where my red cells were too big. They did nothing no other tests at that time.

[fbirder in reply to 1Cazza]

The big red cells (macrocytosis) can be caused by low B12 and/or low folate (and some other stuff). It probably is best to ask for the MMA test and a full blood count including MCV and RDW (Mean Cell Volume and Red cell Distribution Width).

[Polaris]

You've had gastric surgery 1Cassa, so it's absolutely essential that your GP ensures you do not become deficient by monitoring and treating with B12 injections for life, as set out in the guidelines and latest research below. I suggest you write a tactful but firm letter to the surgery and take someone with you for moral support to your next appointment to ensure that the surgery comply:

BCSH Guidelines - See B12 deficiency guidelines on page 4 :

bcshguidelines.com/4_HAEMAT...

(Bottom of page 10) :

"Poor absorption due to gastrointestinal surgery or disease.

1 Patients who have had gastric surgery have a high preva- lence of cobalamin deficiency (Sumner et al, 1996), "

..............

Also latest BMJ research document :

cmim.org/pdf2014/funcion.ph... :

Page 2

Box 1 Common causes of vitamin B12 deficiency5-

* Impaired gastric absorption

• Pernicious anaemia• Gastrectomy—partial or total • Zollinger-Ellison syndrome

Page 5 :

"Summary of treatment and management of vitamin B12 deficiencyIdentify and treat the cause

Administerhydroxycobalamin(parenteralvitaminB12)1mgintramuscularlyonalternatedaysfortwoweeksifthereisnoneurological involvement

Prescribe lifelong maintenance parenteral vitamin B12 treatment with hydroxycobalamin 1 mg intramuscularly every three months if no neurological deficit, or every two months if there is neurological deficit to all those with irreversible malabsorption or after gastric surgery, pernicious anaemia, and any other irreversible cause "

Good wishes for better treatment.