homocysteine, intrinsic factor and Parietal cell antibody tests results?

[jbthyro]

Hi,

I have been reading other posts and now have received my fathers results for the B12 followup tests.

I convinced his GP to give him B12 injections of hydroxy 1000mg over a 2 week period back in September. His neurological symptoms improved dramatically, depression and suicidal thoughts disappeared but he is left with extreme anxiety now.

His B12 was 412 and I continued him on 5000mcg lozenges from Jarrows until 2 weeks ago. Out of the blue the GP finally agreed to do the homocysteine and intrinsic factor tests as well as Parietal cell auto-antibody test, so he was still supplementing at the time. These test results have been read out to me over the phone (parents NOT computer literate but I am travelling to see them tomorrow!) but I would be I would like to gain a little knowledge about how they look to those of you who understand them if that is ok? His GP rarely show the ranges because they printout 6years each time on one sheet to save costs! GP wants to see him Monday so I am going down to be with him at the appointment.

B12 - +2000

Folate - >20

Homocysteine - 14.2

Intrinsic Factor - XaDsn - negative - PPV of 95% low sensitivity 40 (-60%)

Immunology

Parietal Cell Auto Antibody - XE2pi) blood - positive gastric parietal cell antibodies non-specific marker for autoimmune disease P.A intrinsic factor

Mitochondria anti-body Screening Test - normal result - anti-smooth muscle auto antibody level (XE2ph) blood - result negative

Microsomal - negative

Nuclear Auto Antibody Screen - negative

Investigating his Thyroid too:-

TSH - 4.02

Free T3 - 4.9

Free T4 - 17

Parathyroid - 4

I am going to get a Blue Horizon Full Thyroid 12 test done next. May have to get the saliva Cortisol test sent off too!

Cortisol serum - 407+

Ferritin - 25

Iron - 15

celiac antibody test - 14 (0-15)

Thank you in advance for any advice given

jbthyro x x

[Gambit62 Administrator]

Difficult to interpret without ranges and units (there are different assay methods so different ranges can apply to same tests.

B12 and folate are both over the range - presumably the result of supplementation so not unexpected - though may get some angst from doctor about stopping supplementation.

IFA has come back negative but it's prone to false negatives so doesn't rule out PA

PCA isn't a particularly good test and give false positives as well as negatives.

Ferritin looks on the low side - not sure what the iron result means - would need range and units - but that could indicate that your dad isn't absorbing food from his diet so low stomach acidity.

Did you keep a diary of your dads symptoms before and after supplementation?

Was the anxiety there or is it something that is new? Some people can have problems with methylcobalamin and it can lead to anxiety - so worth seeing if you can get hold of some hydroxo sublinguals to test that out. Or it could just be that sublingual isn't a method that works for your dad and although his levels are really high they aren't sufficient for him any more there is a functional deficiency going on and there isn't enough going on at the cell level - which is where MMA and homocysteine tests can help.

[jbthyro in reply to Gambit62]

He did have anxiety before, but the depression/suicidal thoughts over-rode the anxiety at that time!

My mum has been keeping a detailed diary which I will go through with her today when I get there. Luckily the GP appnt is not until tomorrow at 5pm so I should have time to gather the evidence I need! lol.

Getting some hydroxo sublinguals is a good idea.

And the MMA - I have heard that the urine one is more reliable than the serum, anyone else heard that?

[Gambit62 Administrator in reply to jbthyro]

not that MMA in urine is more reliable just that it is easier to correlate with other potential causes of raised MMA, so other tests not needed - however, it's rare to see MMA in urine done in the UK, assuming you are in the UK - if in the states then it is feesible.

[jbthyro in reply to Gambit62]

We are in the UK, but thanks, I'll look into it

[fbirder]

Assuming that the hCys result is 14.2 umol/L - that is on the high side. Which would indicate that, despite high levels of serum B12 there's not enough getting into the cells.

With a caveat - I don't know how quickly hCys levels drop after treatment starts. It may be that it was much higher before treatment started and that it's been dropping since. I'd like to see another, lower, result.

High hCys, positive anti-GPC antibodies and a positive response to B12 treatment - in combination - are highly suggestive of Pernicious Anaemia.

Sorry, can't help with the tyroid stuff.

[fbirder in reply to fbirder]

I don't know how quickly hCys levels drop after treatment starts.

OK, it seems that it drops quite quickly. This paper - ncbi.nlm.nih.gov/pmc/articl... - reckons it's several days.

It is possible, as wedgewood suggests, that the B12 isn't getting into the cells. A MMA (Methylmalonic Acid) test would check that.

Another possibility is that your father has difficulty converting folic acid into methylfolate (about 9% of the population have a genetic defect that can cause this problem). Taking methylfolate tablets (available from Amazon) would fix that.

There are other possible causes for high hCys levels - age and gender may be the explanation (14 mmol/L isn't exceptionally high for an older male). Or it could be not enough B6 - ncbi.nlm.nih.gov/pubmed/172... - so get that tested.

It may also be worth getting kidney function tested.

But don't fret too much. As I said, it's not very high for an older gent.

[wedgewood]

The homocysteine level is rather high - 7 would be better . The B12 isn't getting to the cells .

[jbthyro]

Wow, thank you everyone for your thoughts!

fbirder, I will look through that paper on hCysn in case I need it.

I think the MMA test would be a good idea, I have asked his GP twice to do this before the injections but then I did ask for the hCyst to be done before too and it never was so that it was before any B12 injections were offered.

The reason I am pursuing this is to identify whether it is in fact P.A so that we can see if his anxiety improves, especially as the depression/suicide feelings stopped after the 2nd of 5 B12 injections in Sept. It is a shame that the loading doses didn't continue until symptoms eased. I don't know what the doctor will say tomorrow so I am trying to arm myself with all the information beforehand to help educate the GP as I am expecting him to see the B12 result of 2000 and withold any further injections.

He might surprise me though! He has at least been pro-active and done most tests that I have asked for, so I am lucky that he seems to be helping.

fbirder, I have been dosing him up with B6 100mg since Sept because I read that it may help neurological problems, along with a few other supplements. I was going to ask if this could be tested anyway to check his levels so that ties in with your idea.

I know that the B12 injections were 1000mg of hydroxycobalamin.

I was giving him methylcobalamin lozenges afterwards as I wanted more loading doses really.

[Marz]

The TSH result indicates the Thyroid is struggling. In healthy people the TSH is around 1.5. The Thyroid Anti-bodies were not tested - another auto-immune condition - Hashimotos.

thyroiduk.org.uk/tuk/testin...

The chart in the above link may be helpful .....