I have over the years had a number of blood tests carried out (for Thyroid function/Celiacs Disease etc) some privately and some through my GP (who has been helpful to a point) to try and get to the bottom of why I am suffering from a number of symptoms a lot of which fall under the B12 umbrella.
The latest results of the private test (see below) flagged up a folate deficiency (which kind of led me to this forum), I have read through a number of the links but my knowledge is pretty minimal so any advice/help would be much appreciated.
Is this something that needs addressing?? Should I be looking to get further tests carried out follow up on this?
The serum B12 test is one that needs a lot of interpretation as people vary a lot so ranges aren't as useful as you might imagine - symptoms is the key element
there are some other tests that can help clarify but all of them need a degree of interpretation. homocysteine and MMA are waste products that the body needs B12 to recycle into useful building blocks. However, homocysteine will also be high if you are folate deficient so won't be a useful test in this case - but MMA might help.
Would also be good to have a full blood count to look for any signs of macrocytosis (enlarged rounder red blood cells), though your ferritin looks as if it is a little on the low side so there might also be an iron based anaemia going on which would act in the other direction.
low ferritin, folate and B12 can be indicative of an absorption problem
it might also be worth looking at vitamin D as well
Suggest that you post results again on TUK for support on the thyroid elements. Your TSH is below normal range.
symptoms of thyroid, B12, folate and iron deficiency overlap a lot so unravelling what is going on even based on symptoms is likely to be problematic - especially in a world where GPs are prone to think test results give them all the answers
Hi Wellr. Hello and welcome. First, apologies 'cause it's a bit late and I'm just about out of brain, so leaving a few words so you have a reply and somewhere to start, then perhaps you could come back with more question in a new post when you've read some things that I'm going to suggest?
First - your results - good idea to post you thyroid results on the thyroid UK forum - search the communities on HU and it will pop up. They're much better a thyroid than we are 😀.
Next - CRP - high sensitive - this blood test is a general test for inflammatory markers - it won't diagnose any condition but it does tell you if an inflammatory process is going on in the body. High sensitivity means that it's likely that this is happening to,you and your GP should want to investigate is further.
Ferritin looks nearly okay (your GP,will say it is fine). Better if you could get it up to 100 (your GP can give you supplements. He might want to do a full iron panel to show true iron status (serum iron, transference and saturation).
Your definately have a folate deficiency. B12 and folate work together so if folate is low then your body cannot utilise B12 properly. (More about this in a minute).
Your B12 result is within the normal reference range so your GP might think that there isn't a problem but..being in the reference range is not good enough for some people. It is possible to have the symptoms of B12 deficency whilst having what looks like an okay B12 level.
All the guidelines say treat the symptoms, not the blood levels - but not many GP's know that. An added complication is your folate level - this needs treating with supplements but treating a low folate level in the presence of a fairly low B12 level can cause problems (mask a potential B12 deficency and cause neurological damage to occur). If your GP gives you folate and your body is then able to properly process what B12 you have (which it may not be doing now) then your current B12 level will fall further (because it is being used) and you may well end up with problems (because the folate supplement will act to 'hide' a potentially increasing B12 deficency).
So...you have the symptoms of B12 deficency...which your GP should treat...and at the same time, should also give you folate supplement (folate should only be started 24 hours after B12 injection - to prevent neurological damage).
As your levels are low (but not classed as deficient in the reference range) you might have trouble getting you GP to treat you - many do. Here's an a link to a NEAQS B12 Alert - print it and take it to show your GP - it might persuade him to treat you (it certainly should do):
It is particularly important that you have treatment immediately if you have neurological symptoms - again, your GP might not know this.
Suggest you read the PAS pinned posts to the right of this page when you log on (or at the bottom if using a phone). They give information about the diagnosis, treatment and guidelines relating to the treatment of PA and /or B12 deficiency (both treated the same - B12 injections). You'll also find a symptoms checklist - you may find that you have symptoms that you didn't realise we're symptoms.
These will help you to understand how your doctor should be treating you - and also help,you to understand what you should be asking him to do. You might have to highlight the bits relevant to your case and make sure he reads them while you are there with him. Many GP's are not well informed about either condition and sometimes need a little help (or a big push) in the right direction - the direction that means you getting the right treatment 😀.
More tests - be good to have a full blood count (FBC). Will tell you if you have large red blood cells (megoblastic anaemia related to PA, B12 and folate deficiency) and also identify if you have iron deficency anaemia (which you can have even with a fairly decent ferritin level).
Also - ask for anti-IF antibodies blood test. If it's positive, you definately have pernicious anaemia. If it negative it's only 50% accurate and you could still have PA. Worth noting that if anybody in your family has an anutiommune condition, it ps likely that you could have one also (PA is an autoimmune condition too). And if there are autoimmune conditions, your GP may like to do a full antibody screen to rule out other autoimmune conditions as a cause of,your ill health.
Sorry...this feels as if I've been a bit rushed...but at least it's given somewhere to start.
When you've read the information you're bound to have more questions. And you may well need more help getting your GP to treat you - particularly important if you have neurological symptoms. So please post again if and when you need more help. The site's a bit quite at the moment but there are usually lots of people popping in to help.
Good luck and let's us know how you get on 👍
P.s. It's best not to take any Supplements containing B12 before testing and investigations are completed - these will skew test results. If you have taken any, these will have raised your B12 levels enough for your GP to think they look okay, but not enough to effect proper repair. So best tell him if you have taken any so it can be taken into account when thinking about your current B12 level. Remember, it's the symptoms that should be treated, not your serum B12 levels 👍
UK B12 document that gives recommended process for diagnosis/treatment of B12 deficiency.
b-s-h.org.uk/guidelines/ click on box that says "Diagnosis of b12 and Folate Deficiency" should be on page 3 or put "cobalamin and folate guidelines" in search box.
Link below to flowchart in BSH Cobalamin guidelines that shows when an IFA (intrinsic Factor Antibody) test should be ordered. IFA test can help in diagnosis of PA (Pernicious Anaemia) but does not always give a reliable result. Its possible to have PA with a negative result in IFA test (Antibody Negative PA).
6) Pinned posts in this forum. I found the summary of B12 documents compiled by fbirder very useful. Link to his summary in third pinned post (last link in list).
7) Book "What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency"
8) Book "Could it Be b12" by Sally Pacholok and JJ, Stuart
9) I learnt a lot when I first joined this forum by reading other people's threads.
It is possible to have severe B12 deficiency with a b12 blood result that is within normal range. See point 5 in link below.
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Blood test results advice needed!
