Pernicious Anaemia Society

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I am here to ask about more testing before starting B12 and folate, I spoke to GP today and he has started me on cyanocobalamin tablets and 210mg ferrous fumarate once a day because of low ferritin and complete blood count/iron profile results. Doctor prescribed me folic acid 5mg and ordered coeliac test because of low vits. Would this be correct? Thank you in advance.

B12 138 (180 - 900)

FOLATE 2.3 (2.5 - 19.5)

FERRITIN 15 (15 - 150)

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Lauren, did you go to a GP or rheumatologist?

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I went to a GP.

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I am going to the rheumatologist tomorrow. I'll let you know what he tells me.

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Good luck. Hope it goes well. :)

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Thanks :)

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Hi Lauren07 Do you know why you are B12 and Folate deficient? Look at the following and see if you are one (or more) of the "people" in the list:

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.

If you have coeliac disease symptoms will include Iron, vitamin B12 or folic acid deficiency so I think your doctor has maybe prescribed treatment on that assumption, but it would be good to be aware of the other causes just in case the test comes back negative.

I wish you well

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does your diet contain meat/fish/dairy/egg. If it does then it is unlikely to be a dietary deficiency and more likely to be an absorption problem - and in that case the tablets you have been given aren't going to help.

If you eat good amounts of meat/fish/dairy/eggs then I'd suggest querying the treatment as the evidence is that your deficiency isn't caused by diet but is caused by an absorption problem - although current NICE guidelines aren't as clear as they could be - treatment for an absorption problem would be loading doses followed by maintenance shots (if it isn't a reversible cause - basically a h pylori infection). Ideally your GP should try to find out what is causing the absorption problem.

Also, assuming that your diet is well balanced in terms of sources of folate (fruit and veg), being low in folate would also indicate an absorption problem.

ferritin is a reasonable indicator of how much iron you have - though really getting a full picture involves a full blood count. If you have both iron deficiency and b12/folate deficiency the full blood count in relation to red blood cells is likely to be rather difficult to interpret though as iron pushes to smaller red blood cells and folate/B12 deficiency to larger rounder red blood cells.

It might also be worth making sure your GP is aware that macrocytosis isn't present in 30% of people presenting with a B12 deficiency. Also if you have neurological symptoms then treatment with shots should not be delayed or there is a risk of permanent nerve damage.

Given the level of your B12 results (and this is being very cautious), I'd be inclined to hold off on the folate treatment for a while as you should ideally start B12 treatment 24-48 hours before folate treatment as there is a very very small risk of nerve damage if high dose folate is used in the presence of a significant B12 deficiency.

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With such a low level of B12 I very much doubt that prescribing cyanocobalamin tablets is going to make much difference. Do you know what the dosage is? A lot of GP's (mine included) prescribe 50 mcg tablets - about as much use as smarties! As others have said, injections (or high dose sub-lingual tablets) are the way to go .....

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I can vouch for that the injections made me feel normal within the first 24 hours of having them. This time I have been given tablets which are doing nothing well except I now have vitamin D deficency and fatty liver. My diet has been same for over ten years

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