Is this the right test?

[Orpheusss]

I've been diagnosed with B12 (113) and folate (3.1) deficiency. I'm getting the loading injections at the moment. The doctor has given me a blood test form to get a "gastic parietal cell antibody" test. Is this the right test? I thought I should be getting the Anti intrinsic factor antibody test as that is what it says on the NICE guidelines. I'm confused.

[clivealive Forum Support]

Hi Orpheusss the whole relevant section reads and is telling your doctor to:

"Determine whether there is an underlying cause for the serum vitamin B12 deficiency (for example pernicious anaemia), by checking for serum anti-intrinsic factor antibodies.

Note that testing for anti-intrinsic factor antibodies is recommended in people with strong clinical features of B12 deficiency, such as megaloblastic anaemia or subacute combined degeneration of the cord, despite a normal vitamin B12 level. For more information, see the section on Interpreting results of investigations.

Checking for gastric anti-parietal cell antibodies is no longer recommended to diagnose pernicious anaemia.

Determine whether the person has experienced complications of anaemia, or of vitamin B12 deficiency."

Are you exhibiting strong clinical features of B12 deficiency? What symptoms do you have?

Perhaps your doctor is trying to rule out another cause of your deficiency before checking your Intrinsic Factor.

What sort of diet do you have? What other medications are you on? What surgery have you had done? Do you have any other autoimmune diseases? Do yo have tummy troubles? The list of questions goes on and on.

Have you been prescribed folic acid for your low Folate?

I'm not a medically trained person but there are others on here who will be able to give you good advice.

[Orpheusss in reply to clivealive]

Thanks. Yes, I've been prescribed folic tablets (5000mg). My diet is not likely to be a factor as I eat meat and dairy products daily. My only symptoms are mental and physical fatigue. I've had four shots of hydroxocobalamin so far

[Sleepybunny]

Hi,

If you're in UK, I'd suggest reading the whole BSH Cobalamin and Folate Guidelines which outlines diagnosis and treatment of B12 deficiency and PA. I gave a copy to my GPs.

b-s-h.org.uk/guidelines/gui...

Flowchart from BSH Cobalamin and Folate Guidelines below.

stichtingb12tekort.nl/weten...

Flowchart outlines when PA and Antibody Negative PA can be diagnosed in UK and specifies what tests to carry out on someone with suspected B12 deficiency. Some GPs are not aware that it is possible to have Antibody Negative PA (Pernicious Anaemia where result in IFA Intrinsic Factor Antibody test is negative).

Risk Factors for PA and B12 deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

B12 Deficiency Symptoms Lists

pernicious-anaemia-society....

b12deficiency.info/signs-an...

b12d.org/admin/healthcheck/...

B12 books

"What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper. Martyn Hooper is the chair of PAS. Book is up to date with UK guidelines.

"Living with Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper, has several case studies which I found interesting.

"Could it Be B12; An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)

Very comprehensive book about B12 deficiency. Lots of case studies.

B12 blogs

martynhooper.com/

Also an interesting blog on "B12 Deficiency Info" website.

I'm not medically trained just someone who has struggled to get a diagnosis.

[Orpheusss in reply to Sleepybunny]

Thanks for that

[Gambit62 Administrator]

GPCA is a test for PA but the NICE and BCSH guidelines don't recommend its use as it is prone to false positives - WHO don't recommend it for the same reason.

GPs aren't always aware of the current guidelines.

[Orpheusss in reply to Gambit62]

Yes, so basically it could back positive and it might not be PA. Not good.

[clivealive Forum Support in reply to Orpheusss]

You don't necessarily have to have P.A. to become Vitamin B12 deficient and despite your good daily "meat eating" diet if you have an absorption problem with your stomach or for other reasons your doctor will want to find the cause.

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.

You can "rule out" line one but can you see yourself among any of the other "people"?

[Orpheusss in reply to clivealive]

No. None of those would apply to me.