Help please!

[goldpeak93]

Hello all. I am a healthy 24 year old male. I met with my GP a couple weeks back about hand tremors I've been having. Got a full-spine MRI, and nothing abnormal was detected. He did a lot of blood work though, and 2 results came back abnormal (positive ANA and B12 @ 955 pg/mL). He doesn't seem to concerned about these results, but is sending me to a rheumatologist just to make sure. Do these levels seem alarming to anyone?

[Gambit62 Administrator]

some people do respond to high levels of B12 in serum by shutting down the mechanism that allows the B12 to get from your blood to the cells. This is called functional B12 deficiency. Might be worth looking at a couple of tests that would pick this up - waste products that will be raised if your cells don't have enough B12 to recycle them - MMA and homocysteine - but both can be raised by other factors so need to be done in a context.

B12 isn't actually toxic which is why it doesn't ring alarm bells for most GPs but raised B12 can be one of the early symptoms of some renal and liver problems as well.

ANA is a test for antibodies that may indicate auto-immune conditions - can't really help with interpreting that one though - certainly not on the basis of just two results.

[goldpeak93 in reply to Gambit62]

Thanks for the response! Doc ran 12 other tests, and all of those came back normal. I'm sure everything is fine, so I'm going to try to not worry until I see the rheumatologist in 2 weeks.

Concerning the ANA results, my titer was only borderline positive (1:80). Based on my research, AI conditions tend to shoot this number a lot higher.

[Foggyme Administrator in reply to goldpeak93]

Hi goldpeak93. Yes, that is quite a low titre (mine were 1:1600 when diagnosed with an autoimmune condition).

But your GP has done the right thing in referring you to a rheumatologist for further investigation (if only to put your mind at rest).

As you probably know by now, your rheumatologist will run a full antibody screen for a whole host of autoimmune conditions, including (but not limited to) rheumatoid arthritis, lupus, sjogrens...and heaps of other things.

The rheumatology will (or should) also take a quite detailed medical history. When I went, I discovered that some things I had not associated with a possible autoimmune condition were highly significant in the scheme of things (problems with Achilles' tendons, frozen shoulder, Morton's neuroma, sinus issues, blurred vision...

So...good idea to make a list of anything and everything that might have occurred in terms of possible symptoms (no matter how diverse or unconnected you may think they are).

Autoimmune conditions are also more likely if someone in your family has one.

Not sure what information you've found about all things ANA, but here's a link to some information that may (or may not) be useful:

mayoclinic.org/tests-proced...

Just wondering - did your GP do blood tests for ESR and CRP (so called inflammatory markers)...if raised, these tests indicate that inflammatory process are at work somewhere in the body - rheumatologist will follow this up with more tests - and probably repeat again, even if they were done and were normal last time.

Having said all this...it is quite possible to have a positive ANA result - and not have an undelaying autoimmune condition...particularly if the titre is low.

So...the test will be over and against a complete medical history and the clinical presentation of symptoms (or not).

Gambit's already done B12 but post again if you start to think that might be a problem and you need more help or advice.

Very best of luck with the rheumatology appointment...let us know how it goes.

👍

[goldpeak93 in reply to Foggyme]

Thanks for the long response! The only symptoms I'm experiencing are tremor and fatigue. Just finished my first semester of grad school though, so I assume that's where the fatigue is stemming from. I'll make sure to give him as detailed a history as possible.

Yes, I had ESR and CRP tests run. ESR was 0 mm/hr and CRP was <0.1 mg/dL. Had many other tests ran which all came back normal, including RF, RPR, and CMV.

I'll make sure to update after my appointment!

[Foggyme Administrator in reply to goldpeak93]

Thanks goldpeak93. Will be good to hear how you get on 👍