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Pernicious Anaemia Society
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Low b12 and folate? Is that doubly bad?

Hi all,

Husband has all symptoms, b12 level 173, told this is just below the average range which is 180 -20000 here. Told they will retest in 1 - 3 months.

Just got paper copy of blood test results. Folate is 2.8 which is the very lowest of average. Range 2.8 -20

Mean cell volume 90.0 range 78-98

Mean cell hb 31.8 range 27.0 -32

Mean cell hb conc. 354 range 310-360

Does the folate being low change anything ? Anybody advise on the mean cell stuff ?

Drs also looking at addisons lupus etc.

Thanks in advance


7 Replies

Many blood cell test numbers are derived from I think 3 measurements. The evidence of nothing being wrong can appear overwhelming, as a result, even though it's based on just a few measurements.

My bloods looked normal too, with the exception of B12. Folate eventually dropped to 3.1 from 5.6. It appears this is malabsorption in my case and therefore maybe in your case too. Just because all the blood test numbers don't support the B12 deficiency picture, it does not mean there is no deficiency.

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Thanks for the reply, it's interesting that My husband's folate is lower than yours is when you were diagnosed.

Thanks for sharing that you were in the same boat with normal levels and that this does not mean much


Well just screamed at the retest in 3 months ...

Is your husband symptomatic of B12 deficiency:


serum B12 is a rough guide at best - taken as a single indicator it will miss 25% of people who are deficient but also pick up 5% who aren't

If your husband has any neurological symptoms then treatment really shouldn't be delayed ... and B12 treatment should start 24-48 hours before starting to treat a folate deficiency.

MCH and MCHC are close to the top so could be a sign of macrocytosis starting - which is a classic symptom of both folate and B12 deficiencies. If your GP is waiting for this to become clear then you need to point out that 25% of people with B12 deficiency present without macrocytosis - its a symptom not a defining characteristic.

What are your husbands iron levels like - if these are low then that will lead to microcytosis (red blood cells smaller) so can disguise macrocytosis ... but the Red Blood cell distribution width is likely to be higher than normal if both are going on at the same time.

If you have multiple vitamin and mineral deficiencies then that would suggest an absorption problem - PA would be a prime candidate - as would coeliacs.

This does of course assume that your husband has a properly balanced diet - good amounts of green leafy veg for the folate and meat/fish/dairy/egg for B12. If not then B12 deficiency could be diet related and could be corrected by 50mcg tablets. If it is an absorption problem then these tablets won't be effective.


Thanks for your reply, it's really helpful. Particularly about the cell volume which I didn't understand at all. It doesn't appear they have tested the iron as it is not listed on the sheet results.

He does have a normal diet. Symptoms are fatigue, sweating, inability to concentrate, headaches and some dizziness.

Spoke to the Dr about PA and he said he would prefer to wait and retest, we could push it but this is the first time a Dr has actually listened to us and want to keep him onside. He is the only gp to run the addisons test and lupus etc, the hospital in 2104 just said come back if you faint again. We just got a print of the cortisol result, which is normal but did not rise enough after the Sst test. On that bit of paper it listed the folate which hadn't been flagged as low and we didn't know this when we agreed to wait. Dr is the only Dr to run B12 test after all these years, and he has another patient he is treating for B12 deficiency so he seems on the ball.

Its so hard to work out what to do for the best.

Thanks again.

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only one patient that he is treating for B12! think there are probably a lot more patients that he's assuming are okay but who aren't. He may be more on the ball with B12 than other doctors but only because the standard has been set so low.

sorry - just a bit cranky this evening.

I'd try to get the rest done in a month - sooner if the 'dizziness' doesn't resolve or gets worse.


Thanks Gambit, I understand. I will try to get the retest as soon as possible. It's been two weeks already, so not long now.

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There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Folic acid is crucial for proper brain functioning and plays an important role in mental and emotional health and works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.

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