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Pernicious Anaemia Society
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Iron results help please

I have been posting on the Thyroid forum for my wife (hypothyroid) as that is the main issue (I think). Also low Vit D, B12 and Ferretin.

She is constantly fatigued but any of the above could be causing or contributing to that.

I was pointed in this direction for more iron advice.

Iron studies done.

Serum iron level 17 umol/L (10-33)

Serum transferrin 3.48 g/L (2.5-3.8)

! Unsat iron binding capacity 87umol/L (36-77)

Transferrin saturation index 19%

Serum Ferritin 18 ug/L (10-291)

Vitamin D 59 nmol/L (75-150)

! Serum total 25-OH vit D level - slight vitamin D deficiency - collect leaflet from desk (leaflet was about diet!)

Serum vitamin B12 323 ng/L (181-910)

Serum folate 8.3 ug/L (>5.40)

Serum creatine 82 umol/L (53-97)

Have lots of other results but most are middle of their relative ranges.

A few years ago the Serum Ferretin was 12ug/L and GP treated with a course of ferrous fumarate but that was stopped once it got up to 57ug/L. But has dropped again to its current level.

I have purchased some ferrous fumarate over the counter but is this the right way to go with the unsat iron binding capacity being over range?

I read a bit on the rt3-adrenals.org site and I think it points to supplemental iron if i'm interpreting correctly.

Just want to be sure, my wife is sceptical of treating herself despite the GP treating the numbers and not how she feels.

I have ordered supplements to get the other vitamin levels up too.

With regard to the vitamin B12, the thyroid forum have recommended an optimum level of 600+ ng/L. In your experience what level of supplements would get her up to that level and how long would it usually take. I appreciate that is possibly an un answerable question as we are all so different.

Would an injection be better? (not sure I could convince her to self inject) but if tablets take a long time she may come around to it.

Any advice is much appreciated.

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This forum is actually about one particular absorption problem that leads to a B12 deficiency which will eventually cause macrocytic anaemia. The condition can also cause problems with absorbing other vitamins and minerals so some people do also have iron based anaemias but as you can overdose on iron I would recommend that you actually talk to your wife's GP, or a pharmacist at the very least.

It would appear that your wife does have an absorption problem - and it would probably be more efficient to ask GP to look into what this could be.

In relation to the comments on the TUK about levels of 600+ng/L this is, as far as I can tell, based on quoting information out of context. Most people, including people with thyroid problems will be perfectly okay with levels that are much lower than this. On the face of it your wife's result is actually quite a good level.

Folate may be low but is in range - best form of folate is from food so suggest looking at dietyl

What is problematic is treating people based just on looking at test results. Serum B12 is not a gold standard test - whilst it will miss 25% of people who are B12 deficient it will also pick up 5% who aren't. Some people do not respond well to raising B12 levels above normal range - easy to do if you go for high dose supplements - as it can result in problems with the mechanism that allows B12 to move from blood to cells. Symptoms should always be evaluated as part of the context.

you can find a list of symptoms here

pernicious-anaemia-society....

further tests that can clarify are MMA and homocysteine which will be raised if cells don't have enough B12 to recycle them but they can also be raised by other things (which for homocysteine includes folate deficiency) - so need to be looked at in context.

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Thanks for the reply and apologies if I have posted in the wrong place, I may have wrongly assumed that people would know more about iron here. But if it is only specific to PA and my wifes results are not indicating an issue other than absorption then I guess its back to the GP maybe see if they will do the MMA or homacysteine tests.

Looking at the symptoms list there's a lot she could say yes too, but most are shared with thyroid issues too.

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not a problem wtih posting - just wanted you to be aware that there was a strong possibility that you wouldn't get a response on this forum.

Sometimes it is easier to rule out thyroid first and then come back to B12.

If there are absorption problems then its best to look at those as well and get tested for Coeliacs and PA - though the test for PA (IFA) is prone to false negatives so is a long way from proving that you don't have PA.

May well be worth monitoring B12 levels over time - downward trend would point to a deficiency.

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