Pernicious Anaemia Society

Full bloods - low B12, low neutrophils and other white cells, low vit D - please can anyone offer advice on next steps and supplements?

Hi all,

I have been trying to make sense of the data I now have (ta-daa) from GP... but there is a lot of info and I see others have asked for help interpreting - so am following suit. Overall, there are few things out of range but others that seem to me near the edge of ranges and I thought perhaps you knowledgeable people could help me figure out my next steps (I'm currently self-injecting B12 every 2 days 'until symptoms stop improving' as in NICE/BMF guidelines and can now feel two of my toes for the first time in 10 years).

I had very rapid menopause at 46 (7 years ago - over before I noticed) and have had worsening osteopenia since 38 with some osteoporosis now. So I'm worried about my bones... bad osteoporosis runs in my family, I'm doing well compared with others and want to keep it that way. Not on HRT.




There is a lot so I'm trying to mention what I think matters..writing u for micro. Sorry for the length of this. ! indicates out of range as on GP's results. Ranges in brackets after the measurement.

! Serum B12 170 ng/L (180 - 900) -- LOW

Serum Ferritin 112.1 ug/L (10-200) - ok (has been low in the past)

Serum folate 4.2 ug/L (3 - 20) - on the low side? GP said was ok

Serum iron 25.8 umol /L (11- 30) (wow, has often been low over the years)

Serum transferrin 2.16 g/L (1.8 - 3.6)

! Transferrin saturation index 54% (16 - 50) marked as !, not sure if it matters?

! Total white cell count 3.76 x 18*9 / L (4 - 11)

(Haemoglobin, platelets, haematocrit, RBC all in mid range)

MCV 91.7 fl (83-105)

MCH 31.8 (27 - 32) at the high end?

! MCHC 346 g/L (315 -345) just high, not sure if it matters?

! Neutrophil count 1.73 x 10*8/L (2 - 7) LOW

Lymphocyte count 1.56x 10*9 / L (1 - 4) so LOWISH in range...

Monocyte count .38 x 10*9/L (0.2 - 1) so LOWISH in range

Eosinophil count 0.06 x 10*9/L (0 - 0.5) so LOWISH in range

Basophil count 0.03 x10*9/L (0 - 0.1) so LOWISH in range

HbAlco 4.7% (4 - 6) so No Diabetes

! Serum vitamin D 42 nmol/L

Plasma corrected calcium level 2.33 mmol / l (2.2 - 2.6)

4 Replies

As you say your B12 and D are low and so is your folate if you are injecting B12 every other day as this gets "used up" and is essential to process the B12.

Do you have any idea why you became B12 deficient?

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Women with a history of infertility or multiple miscarriages.

Do you "see" yourself in any of the above?

I am not a medically qualified person but there are others on here who will be able to help with goo advice on your other test results.

I wish you well.

1 like

Many thanks, Clivealive. I've no idea why this deficiency arose... I don't feel I fit anything on the list except possibly family history (undiagnosed). It could be the eating disorder although I've been fine for 30 years on that. Thanks for the suggestion on folate, I did wonder. And Clutter suggested already I supplement vit D.


You need to increase folate for your B12. Most importantly you need to increase D to somewhere 60 to 80 ng/L . support the D3 with K2 Mk7 and Osteo.


thanks - am planning on folate supplements and also the solgar ultimate bone tabs -- which seem to have the right combination of D3, K2, Magnesium etc.


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