Help and Guidance with blood tests results

[JGBH]

Hi everyone,

Need some help and advice before I see my GP on 12 January.

These are the results:

Serum tissue transglutaminase level (Xalbn) : 0.6 ku/L (0.0 - 5.0). Coeliac serology negative. Coeliac disease unlikely at present time (sensitivity 96%), providing patient taking a normal gluten containing diet. If patient known to have CD this TAG level indicates adherence to gluten free diet.

Parietal cell autoantibody level (XEepi) : Negative

Full blood:

Full blood count: (424)

Total White blood count (XaldY): 6.38 10*9L (4.0 - 10.0)

Red blood cell count (426): ABOVE RANGE 5.24 10*12L (3.8 - 4.8) Outside reference range.

Haemoglobin concentration (Xa96v): 140g/L (120.0 - 150.0)

Haematocrit (X76tb): 0.432 (0.36 - 0.46)

Mean cell volume(42A): BELOW RANGE: 82.4fL (83.0 - 101.1) Outside reference range

Mean cell haemoglobin level (XE2pb): BELOW RANGE: 26.7 pg (27.0 -32.0) Outside reference range.

Mean cell haemoglobin concentration (429): 324 g/L (315.0 - 345.0)

Platelet count - observation (42P): 232 10*9L (150.0 - 400.0)

Neutrophil count (42J): 3.95 10*9/L (2.0 - 7.0)

Lymphocyte count (42M): 1.89 10*9/L (1.0 - 3.0)

Monocyte count - observation (42N): 0.42 10*9/L (0.2 - 1.0)

Eosinophil count - observation (42K): 0.08 10*9/L (0.02 - 0.5)

Basophil count (42L) 0.04 10*9/L (0.02 - 0.1)

RETICULOCYTES

Percentage nucleated red blood cells (42b8): Not detected

Nucleated red blood cell count (4266): Not detected

BLOOD HAEMATINIC LEVELS (XaDsm)

Serum ferritin level (XE24r): 43ug/L (30.0 - 400.0)

Serum Vitamin B12 (XE2pf): 434 ng/L (197.0 - 400.0)

Serum folate level (42U5): 7.5 ug/L (3.89 - 26.8). The folate assay has been re-standardised. Refer to pathology website for more information on changes.

derbyhospitals. nhs.uk/p1

Am looking forward to getting your wonderful advice regarding these tests results.

When I phoned the surgery office to get the results I was told everything was NORMAL.... Glad I requested a copy which clearly show that everything is not normal. Any rational suggestions and piece of advice, and how to approach my GP again would be most welcome.

Many thanks to those of you who can help.

JGBH

[Foggyme Administrator]

Hi JGBH.

Your MCV is below the reference range and your MCH is low in the reference range. This means that you have small red blood cells (microcytic anaemia) often present in iron deficiency anaemia or perhaps as a results of some inflammatory process (just wondering if your RA is under control?).

RBC - your RBC level is above the reference range - looks as if you have too many red blood cells - but wouldn't like to comment on potential causes as your complicated medical history takes this out of my comfort (or competency) zone.

Ferritin level is a little low (though your GP might say that it's in the reference range and therefore okay). Could be sliding down into iron deficiency anaemia (this would be in line with the low MCV and MCH results). Symptoms of iron deficeny anaemia can be similar to symptoms of B12 deficiency (and make you feel quite ill) so worth seeing if your GP will prescribe iron supplements. A good place for ferritin to be is 80 - 100, preferably nearer 100).

Folate could do,with being a little higher - top third of the reference range is a good place to be.

Your serum B12 level is in what's called the 'grey' zone. Within the reference range it's not classed as deficient but...as you are having symptoms (including neurological symptoms) then your GP should treat you for B12 deficiency.

I see from your last post that folks here have pointed you in the right direction in terms of further information that you can highlight and take to your GP to support your request for treatment. In particular, it might help if you focus on the fact that you have neurological symptoms and that all the guidelines state that treatment with B12 injections should begin immediately when these are present. (Highlight the relevant bits and take the documents along to show your GP - good,idea to get him/her to read them while you are there).

Your GP may not know about the neurological regime of injections (see replies in your previous post). Information about this is contained in a book called the BNF - your GP will have a copy on the desk - it's the second item down so he/she may have to read further than they usually do.

You may be told that this regime of injections only applies if you have macrocytic anaemia / PA...but this is a moot point. The treatment for B12 deficiency and PA is the same - B12 injections. And there are many other causes of B12 deficiency - and the treatment is still the same - B12 injections.

Good luck with your GP. Please let us know how you get on and come back if you struggle to get the right treatment - folks here will offer advice on what you could try next.

Take care 👍

[JGBH in reply to Foggyme]

Many thanks for your supporting advice, Foggyme!

Am feeling absolutely wretched and exhausted. Each visit to GP is difficult. It's so obvious I am not well, and yet I need to point her in the right direction all the time. I thought patients should be able to rely on their GPs for guidance and eventually getting better. Am getting so tired of requesting everything.... Don't know how I'll cope if GP is still not doing anything. Changing GP practice is not an option as I live alone and some days I can't even drive, so a surgery in another village is not the practical option.

Will let you know what happens. And thanks again.

[Foggyme Administrator in reply to JGBH]

Hi again JGBH. So sorry that you're feeling so wretched and exhausted. All here will know exactly how that feels and will be willing you on and keeping everything crossed on your behalf.

Here's something you could print and take along with you to show your GP - it might help persuade him to treat you 'grey' zone B12 levels:

archive.is/hbPHE

Good luck 😀

[JGBH]

Hi Foggyme. Thanks for your compassion and link. However where it states "Please click for details" on the UK Nequas form, nothing happens... do I need to do something else to access information fully? Will try my very best as usual... but have little hope. It is not in my nature to let anyone fob me off and placate me but am getting to the point of despair. Thanks for your warm encouragement.

[Foggyme Administrator in reply to JGBH]

Hi JGBH. Just tried it and it seems to load okay.

Just a though...the document you see when the page loads is the one you want... It's just a small one called UKNEQAS Alert...can you see that? Will go back and get the content and paste in a reply just below this one (silly iPad won't let me leave the page and come back without losing this reply).

If you can't see the document try doing a Google search for 'UKNEQAS B12 Alert' it should pop up.

👍

[JGBH]

Hi Foggyme. You're brilliant... Thank you so much, really appreciate your help and support. Will Google... Thanks and good night. x

[Foggyme Administrator in reply to JGBH]

Copy and paste from the document (but GP would probably (hopefully) take more notice of original if you can access it):

Extracted from UKNEQAS B12 Alert:

False normal B12 results and the risk of neurological damage (Please click for details)

“In the event of any discordance between clinical findings of B12 deficiency and a normal B12 laboratory result, then treatment should not be delayed. Clinical findings might include possible pernicious anaemia or neuropathy including subacute combined degeneration of the cord. We recommend storing serum for further analysis including MMA, or holotranscobalamin and intrinsic factor antibody analysis, and treating the patient immediately with parenteral B12 treatment.”

End of copy.

Good luck

[JGBH in reply to Foggyme]

Many many thanks indeed. Keeping fingers crossed now but really need some form of treatment and further investigations re high RBC..

[Foggyme Administrator in reply to JGBH]

👍 Fingers crossed for you - come back if you need more help or advice about getting treatment...it can be so tough getting treatment from GP's some times 😖😀

[JGBH in reply to Foggyme]

Hi Foggyme

Will write tomorrow regarding GP's appointment yesterday... Interesting how they try to avoid everything... Will need more advice and guidance, but too tired now. However your support and advice has been helpful in talking with her.