Pernicious Anaemia Society
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Preparing for GP appointment help please

Preparing for GP appointment help please

Hi Everyone,

I'm so glad I've joined this site as I've had great support so far. Following on from my last post I want to make sure I'm fully prepared for my GP appointment on Tuesday. I was told in a phonecall about 3 years ago by the hospital that I have PA and to go and buy tablets. I never followed it up as I didn't realise how serious it could be. Recently as a result of asking for a blood test I have severe iron deficiency anemia and vitamin D3 deficiency. I have two queries one is from my blood test results below can anyone tell me if I have macrocytic or Microcytic anemia please.

So far I have printed off symptom lists, the BMJ article about vitamin b12 and the BSH guidelines. Also am I right in thinking that PA can cause the iron deficiency.

Also just about the Vitamin D3 deficiency I was given 20,000 iu capsules and told to take 5 a month does this sound like enough. In my first post someone mentioned taking magnesium also could anyone advise what kind of supplement to take please.

Hopefully someone can help as I'm already very anxious about this GP visit.

8 Replies

Hi Carmel13n. I've just scanned through your previous posts and it looks as if there are possibly two separate things going on with you: your previous diagnosis of PA and lack of treatment for the B12 deficiency it causes and your problems with anaemia reflected in your blood tests results above, which I think go beyond an iron deficiency anaemia associated with PA and the B12 deficency and absorption problems PA causes. (There are many different types of anaemia and you can have more than one 'type' simultaneously).

So first, to answer your question about the blood test results above.

The results do indicate that you have microcytic anaemia (small red blood cells) and in terms of the PA (where you would expect to see macrocytic - large red blood cells - the microcytic anaemia will mask this (because any large red blood cells will have been made smaller because of the microcytic nature of your r d blood cells (your GP should not, therefore, assume you do,not have PA - and after all, you've already been diagnosed with this - remember the simple approach I referred to in your second post 😄).

As you will notice all your full blood count tests are marked below range - and some are very very low (goodness, I expect you feel very ill indeed). Your lymphocytes are also below the reference range.

There are lots of different types of anaemia, only one of which is the iron deficiency anaemia often associated with PA. With all your results so low in the reference range, your GP should want to refer you to a haematologist for thorough investigations (if it was me, I'd ask for an urgent referral). There could be a whole number of causes for results like this, only one of which is iron deficiency anaemia, which your GP will want to investigate.

GP may like to do full iron panel (will tell you more about true iron status in the body) and a bone profile test. Also ask to have your folate levels tested (B12 needs folate to,work,properly and levels that bump along the bottom of the reference range are not good enough for anyone with PA). Also assuming that GP will want to check on vitamin D levels to see how treatment for that deficiency is going.

A haematologist should also want to commence B12 injections for your previously diagnosed PA - if your GP is for some odd reason reluctant to do so.

I note that you have previously been told that your serum B12 is 'normal'. First, doctors often say blood results are normal when they're not - bumping along the bottom of the reference range is not good enough for some people. And irrespective of your serum B12 levels, you have been diagnosed with PA so treatment with B12 injections should have been commence immediately upon diagnosis. Your GP should start them now.

When you have PA, your body is not able to absorb B12 from diet in the usual way and your B12 levels will simply keep dropping until eventually - inevitably - there will be none left.

It's quite late now so sorry, I have to stop. Not sure how,you much you know about PA, the B12 deficency it causes, and it treatment so I'm going to paste some links below that will give you some information to help you understand these quite complex and trick conditions - and also help you to debunk some of the stranger notions you may hear from GP's and even hospital consultants (many seem to be quite ill-informed).

Please don't be daunted by what looks like a long list of links. Many of the documents are quite short and they're all quite easy to read. Print them off and highlight anything relevant to your case so that it's easy to find again. And eat the elephant in chunks and read at your own pace.

Most here find that an understanding of the conditions helps when having to deal with GP's - and also give the confidence to challenge people, when necessary.

In your case I think the 'simple' approach (at least in terms of the PA) is best to start with, especially as you have a new GP. As I've said before, just tell your GP you have been previously diagnosed with PA, told to buy tablets which do not work...and want to start on the recommended treatment - B12 injections.

The anaemia (or anaemias) thrown up by your blood results above will have to be considered to - and its possibel that these may involve causes other the PA / B12 deficiency and iron deficiency anaemia - so, request a referral to a haematologist for further investigations.

Good luck and please post again if you have more questions or need more help getting treatment for your PA from your GP.

Here's the links:

oooops...cut and paste is not cutting and pasting. Will have to post this reply (if I leave the page it'll be deleted), go and collect the links, then post them in a new reply below this one.


P.s. fbirder may be able to add further comments about your blood results and further testing if he spots this post.

1 like

I can add more new important thing to Foggyme's comprehensive comments.

That's your Red cell Distribution Width. This gives an indication as to the range of cell sizes. Yours is very high which, when present with a normal Mean Cell Volume, could indicate a combination of microcytosis (caused by a lack of iron) and macrocytosis (caused by a lack of B12 or folate). But your MCV is very low, so I doubt that this is the case here.

I'm a chemist, not a biologist, so I don't know much about microcytosis and don't know if a high RDW is normal when MCV is that low. But it's probably worth asking about.


Thanks fbirder.

A thought...PA often produces a high variation in RBC size and shape (usually giving a high RCDW) - as you say. With perhaps the low MCV being caused by the anaemia (s) that are occurring? With the potentially co-existing conditions giving a complicated blood picture. Hmmm...just thinking...

Complicated blood picture Carmel13n - hope your GP gets on to this quickly for you.


1 like

Hi Foggyme

I have utter respect for your replies etc, and have and continue to learn from them.

Re your para 7(?) above, is it missing a NOT?

"When you have PA, your body is able to absorb B12 from diet in the usual way and your B12 levels will simply keep dropping until eventually - inevitably - there will be none left.'

Sorry - not meant as a criticism - far from it. I am just a pedant.


Grief, thanks Deuto...good spot. Missed out that small but what a difference a little word 😖.

I'm used to the spell checker making nonsense of some things...seems I've joined in 😄

Hurrah for pedant's...I'm one too.



And here's the links:

b12researchgroup.wordpress.... (Serious Caution Note about the use of Oral and Sublingual B12 Supplements) (BNF B12 Deficiency: Hydroxocobalamin Treatment Regimes)

pernicious-anaemia-society.... (PAS Symptom Checklist) (BSH B12 Deficiency / PA Diagnostic Flowchart) (British Society Haematology (BSH) Guidelines: Treatment of B12 Deficiency and Folate Disorders) (UKNEQAS B12 Treatment Alert) (Problems with Serum B12 Test) (Testing B12 During Treatment) (Misconceptions About B12 Deficiency – Good to know before seeing GP) (B12 Treatment Safety / Long Term Treatment for neurological symptoms) (B12 Deficiency, PA, & Relationship (or not) to Anaemia & Neurological Symptoms)

Good luck 👍


Thanks very much Foggyme and Fbirder. I'm very grateful to get some advice and support. I will read and print out all the links before Tuesday and be prepared for the GP appointment. I will also ask to be referred to a Haematologist. When these results came back they were mentioning I might need a blood transfusion but if I agreed to that would that be then harder to find out what is going on.

Hopefully I will get some B12 injections. Thanks very much.


Hi carmel13n. Something clearly needs to be done quite quickly about all your low levels and whilst having a blood transfusion may skew some blood results, it may the case that it would be unwise to delay treatment.

Your GP should refer you to a haematologist so that any transfusion can be carried out under a haematologist's guidance and care.

And there's no reason why a haematologist (or indeed your GP) cannot draw blood for all your blood tests before any transfusion takes place.

With respect to the B12 injections - you should be prescribed these for your previously diagnosed PA in addition to on any other treatment that may be required for any other conditions (iron deficiency, other anaemias or conditions). This is vitally important if you have any neurological symtpoms (as I'm sure you know by now 😄).

Very best of luck...let us know how it goes 👍


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