Latest results from Haematologist have arrived:
Homocysteine: normal 7.2 umol/L
Folate: normal 6.2 ug/L
Active B12: normal >128 pmol/L
MMA 2 days prior to monthly B12 injection: 351 nmol/L
MMA 3 days after monthly B12 injection: 393 nmol/L
The haematologist said this shows that I do not have any functional deficiency. She said that my MMA levels could be construed as 'normal' in some labs (up to 450 nmol/L ??), but could also be "influenced by other metabolic pathways independent of B12 deficiency". She has suggested Small Intestine Bacterial Overgrowth (SIBO) as a possible cause and suggested I have a breath test for this. My GP says she is not able to refer me herself as this is not available as primary care.
I don't understand exactly what is being said here.
Which of these blood tests are relevant to functional B12 deficiency at cell level ?
Is a rising MMA level something to be concerned about, or is this still considered mild (range at St Thomas' : 0- 280 nmol/L) ?
What other metabolic pathways could cause this ?
Is it normal for Folate levels to drop again after 3 months Folate treatment and retested in January (>20) ?
I'm still waiting for results from Genetics lab, one carbon metabolism and cobalamin disorders, although "unlikely the results are going to change management" and the advice remains the same: "B12 treatment at intervals of no greater frequency than that is stated in the BNF "- review in August.
Still very symptomatic, but feeling okay at the moment- had injection on Friday. Any answers to my questions would be much appreciated.