I am here on behalf of my daughter, she is 32 and has pernicious anaemia and Hashimotos. She had her first B12 injection 2 months ago and hasn't been asked back, how often should she have them and should GP be addressing her below range folate?
Thanks for reading.
Vitamin B12 221 pg/L (190 - 900)
Ferritin 33 ug/L (30 - 400)
Folate 2.6 ug/L (4.6 - 18.7)
Iron 6.9 umol/L (6.0 - 26.0)
Transferrin saturation % 13 (10 - 30)
Red blood count 4.46 (3.8 - 6.8)
White cell count 6.18 (4 - 11)
Haemoglobin 120 (115 - 150)
MCV 78.2 fL (80 - 98)
MCHC 376 (310 - 350)
MCH 28.1 (28 - 32)
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Keisha117
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If she is having neurological symptoms her "maintenance" B12 injections should be every eight weeks.
Did your daughter have "loading doses" - perhaps every other day for a couple of weeks, or was the injection two months ago a "one off"?
Your daughter is deficient in Folate.
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 works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.
I am not a medically trained person but have had P.A. for more than 45 years.
Her ferritin is also too low! Is she suffering tiredness and hair loss? She is in range but right at the bottom which isn't good enough for most people. I would consider taking an iron supplements to get this up to at least 70 to 90. Take the iron with vitamin c to help absorption and to make it more gentle on the tummy. It takes a while to raise the levels and then a bit longer for symptoms to improve
Where are you based? treatment regimes vary from country to country. Unless your daughter's problem is definitely dietary then some sort of loading regime would be general practice then followed by maintenance shots - loading does vary - sometimes 3x weekly - sometimes weekly. Maintenance varies from 1 month to 3 months though what really counts is symptoms.
On the folate - yes that needs to be treated - if only because you need both folate and B12 for a number of processes and it is easy for folate to get depleted in the early stages of treatment with B12
The blood results above also suggest that there may be an iron deficiency going on - signs of microcytosis in low MCV and MCH - the ferritin is also on the low side as is the iron. Some studies suggest that people with thyroid problems actually need slightly higher feritin levels - ie bottom of the range might be raised by about 20-30 points.
Have any tests been done to establish if there is an absorption problem?
1) BNF British National Formulary Chapter 9 Section 1.2
All UK GPs will have access to BNF, probably a copy sitting on their desk or bookshelf. It's also possible to get own copy from a good bookshop or internet retailer.
UK B12 treatment info is about a quarter through above document.
In UK, B12 deficiency caused by diet is sometimes treated with oral B12 tablets but B12 deficiency caused by absorption problems eg PA (Pernicious Anaemia) is treated with B12 injections.
In UK, people with B12 deficiency without neuro symptoms are supposed to get 6 loading injections over 2 weeks then injections every 3 months.
People with B12 deficiency where there are neurological symptoms are supposed to get loading injections every other day for as long as symptoms continue to get better then it's an injection every 2 months.
Might be worth joining PAS. They are helpful and can pass on useful info and in some cases intervene on behalf of people struggling to get correct level of treatment. Think this is usually members in UK.
PAS tel no +44 (0)1656 769 717 answerphone available
PAS is based in Wales, UK but has members from around the world. Members can access details of local PAS support groups which may be source of info on helpful GPs etc. Most PAS support groups are in UK but one in USA and one in Australia.
I have read that if folate deficiency is treated it is very important to treat any co-existing B12 deficiency . See Management section in next link about folate deficiency.
I note that Gambit62 mentions the possibility of iron deficiency due to low MCV and low MCH. It's possible that the effects of low iron on the red blood cells are masking effects of low B12/low folate on red blood cells.
Low iron can lead to smaller red blood cells (microcytosis). Low B12 and low folate can lead to enlarged red blood cells (macrocytosis).
having a high red count does you no good when the blood cells are not mature and do not work properly. They don't carry oxygen or iron like they should if you have pernicious anemia. There are different tests for B12.
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First post - B12 & leg cramps
B12 and folate up but ferritin down
B12 and folate relationship.
Vit B12 and Folate reference ranges
