Pernicious Anaemia Society
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newbie blood results

Hi all, i got the results today showing:

Serum B12 as 278ng (198-771)

Serum ferritin 21ng (13-150)

Serum folate 3ng (3.9-26.8)- flagged

RBC 4.81 (3.8-4.8)-flagged

WBC 5.4 (4-11)

Platelet 272 (135-450)

Mean cell volume 85fl (80-100)

Haematocrit 0.41 (0.35-0.45)

MCHL27.9pg (27-34)

RB cell distribution width 13.7% (10-15)

I am being treated for the folate but nothing else has been mentioned, im not sure if anybody can help with assessing whether I have a b12 deficiency?

9 Replies

Hi syl123 I'm not a medically trained person but I'd probably wait to see how you go with the Folate supplement before worrying about the B12.

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Folic acid works with vitamin B12 in making red blood cells and helps iron function properly in the body.

What sort of diet do you have? Do you have any neurological symptoms? What other medications are you taking?

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Hi clivealive, thanks ever so much for responding, in answer to you question I have had vertigo since feb this year and pins and needles in my arms and lower legs,visual disturbances,headaches and stiffness all over in the morning those are the new symptoms but i have been suffering from crushing fatigue, excessive sleeping,muscle weakness tinnitus, extreme iron depletion and weird cold wet feelings in my legs for about 10 years.when i am going through these bad fatigue sessions its a struggle to walk.My tests generally come back negative but have been diagnosed with iron depletion requiring iron infusions .i think this is due to an absorbtion problem?

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A quote from the Patient UK forum re Folate deficiency

"Neurological symptoms (eg, paraesthesia, numbness, cognitive changes, visual disturbance) are more typical of vitamin B12 deficiency but patients with folate deficiency may report mild symptoms of peripheral neuropathy or psychiatric disturbance (eg, depression)"

Is your doctor aware of your neurological symptoms? I think that with your relatively low B12 level he should be treating you with injections in accordance with the N.I.C.E. Guidelines per the extract below:

Treatment for B12 deficiency

How should I treat a person with vitamin B12 deficiency anaemia?

For people with neurological involvement:

Seek urgent specialist advice from a haematologist.

Ideally, management should be guided by a specialist, but if specialist advice is not immediately available, consider the following:

Initially administer hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then administer hydroxocobalamin 1 mg intramuscularly every 2 months.

For the "full story" click on the link below, then on "Management Scenario" and scroll down.

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Thanks clivealive, im seeing the dr next week so hopefully there will be time to discuss all of my symptoms with her, its always difficult timewise and I feel rushed but this needs sorting... i am kicking myself for trusting the blood results for so long when all the time nothing is as straightforward with testing especially for b12 , im going to ask for the other b12 tests rather than just serum b12 and explain all of my symptoms and hopefully fingers crossed i will get the injections that I believe my body has been crying out for, for years.Thanks for trhe link ,I will take a look now.


Make a list of your symptoms and present this to your doctor together with the guidance notes and ask him to treat you according to your symptoms and (perhaps) even restart you on loading doses "until there is no further improvement".

If possible take someone with you who can validate your neurological symptoms as the doctor is less likely to pooh pooh you in front of a witness.

I am not saying that this is an easy thing to do but try to stay calm, write out what you want to say and keep to the script and be confident that you are "in the right" and your facts are correct.

Six years ago I had to battle it out with my "one size fits all" doctor to increase the frequency of my injections after having had them for 39 years and having lived in ignorance of what it was all about all that time. I never knew anyone else with P.A. and believe me ignorance is not bliss.

That's when I joined the Pernicious Anaemia Society and discovered that I was not alone and determined to find out all I could.


Its awful that you had to wait so long to get it sorted but the Pernicious Anaemia Society is such a useful site, i would never of guessed what was really wrong with me until I came across the site by chance and all the pieces of the jigsaw puzzle fits into place.Im going to take a list of all my symptoms (its a long one) but good advice thank you .

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Folate is definitely deficient.

Serum B12 is a difficult test to evaluate -so much variation in how serum B12 levels relate to whether there is enough available in cells where it is needed that the normal range misses 25% of those who are deficient but also picks up 5% of those who aren't.

Symptoms are difficult to evaluate if you have problems with iron and folate as they overlap.

MMA may help to clarify (will be raised if B12 is low).

homocysteine will also be raised but would be inconclusive because it will also be raised by folate deficiency.

the results from full blood count are consistent with iron based anaemia - red blood cells on the small side - folate and B12 can cause macrocytosis in which the red blood cells are larger and rounder than normal - however 25-30% of those with B12 deficiency present without sins of macrocytosis.

suggestions - try for MMA, or sort out the folate and come back to B12 if there are still problems.

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Hi Gambit62 thanks for the advice, its interesting as I have not been diagnosed with iron deficiency anaemia ,looking at the above results am I right in thinking you think I have iron deficiency? Im back at the Dr's on wednesday so want to get it right in my head about what i need to say

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Just back from the GP , with 3 loading B12 injections booked in next week, reluctantly given and only after I quoted BMJ guidelines in relation to neurological symptoms.Wasnt offered iron although mine is low but thought I would fight that battle another day, but at least im getting some b12 although im not sure if im going to be able to notice an improvement after 3 , if there isnt then my GP will stop the B12.Couldnt have got as far without the advice on here from you lovely people including Clivealive and Gambit62


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