Help please

[Dani_79]

Hi I'm new to this site so apologise if this isn't the correct place to post. I've been suffering with fatigue , brittle nails, spontaneous bruising and stomach issues for a number of years( upper right pain, severe nausea,tender stomach)My GP referred me to a Gastroenterologist for celiac test & endoscopy which came back negative. The hospital recommended going gluten free which I have done since I saw them 3 months ago. To cut a long story short when I first saw the Gastro they did bloods my B12 levels were 181 & reported as low borderline I was referred back to my GP for testing again which Ive just had done the levels were B12 206 ( lab range 187-883) and serum folate 4.1( lab range 3.1-20.5). I'm pretty fed up of going to the GP and am quite embarrassed as I feel like a hypochondriac, which I'm really not. I'd just like to get back to feeling "normal" my question to you is could my B12 levels have anything to do with how I'm feeling , they currently aren't out of the lab ranges so I'm assuming the GP will just tell me there's nothing to report. Any replies gratefully received

[Gambit62 Administrator]

serum B12 is not a gold standard test. general variation means that its 'normal range' will miss 25% who are B12 deficient but also pick up 5% who aren't. This means that evaluating symptoms is important and your symptoms do overlap with B12 deficiency.

One common symptom of B12 deficiency is macrocytosis - in which red blood cells are larger and rounder than normal. This can be masked if you are also iron deficient. It is also only a symptom, not a defining characteristic and isn't present in 25% of people presenting with B12 deficiency.

Source of information is BCSH guidelines on diagnosis and treatment of cobalamin and folate deficiencies which your GP can access through the BNF assuming you are UK based. They can also be accessed here

onlinelibrary.wiley.com/doi...

list of symptoms can be found here

pernicious-anaemia-society....

suggest you write to your GP pointing out the above and listing your symptoms and then follow up with an appointment.

The difference between the two test results you have is immaterial and could just be down to variation that you would see on the same sample if tested twice.

Folate is a better test but even so your levels are low - suggesting that you may have absorption problems assuming that your diet is good. If you are going to start treatment for a b12 absorption problem then you would be advised to also supplement some folate - 200-400mcg from supermarket/chemist should be adequate.