Understanding Blood Test Results

[Albie17]

Hi everyone, I'm new here and would welcome some advice on my daughters blood test results. She's 25, has a normal diet - meat, veg and fruit but has ongoing stomach problems going back to when she had Glandular Fever at 18, is always tired, has cold hands and feet and very pale skin. Recently been told she has gastritis and has been prescribed PPI lansoprozole. Her blood test results show:

Serum Ferritin 59 ng/ml

Vit B12 199

Serum Folate 12.5 ug/L

All her other results appear to be within the normal NHS ranges apart from Eosinophils 0.41 10 9/L which is highlighted (range shown 0.0 to 0.4)

Both myself and my mother are unable to absorb B12 from food so have injections every 3 months. Am I right in thinking that B12 deficiency can run in families and that injections could help her too. Our GP just keeps telling her she's depressed!

[clivealive Forum Support]

Hi Albie17 can you please show the ranges <from - to> of your daughter's test results and also were they taken before or after the lansoprazole which will have an adverse affect on her B12 absorption ability?

[Albie17 in reply to clivealive]

Hi clivealive, thank you for replying. Ranges are: serum ferritin 15-300 / B12 150 - 900 and Eosinophils 0.0 - 0.4. These results are from her latest blood test taken in March this year.They were taken before she was prescribed the lansoprozole. I have also noticed that in July 2016 her B12 was 336 ng/L (range 189-900) Serum Ferritin 75 ng/ml (range15-300).

[clivealive Forum Support in reply to Albie17]

Is your daughter's doctor aware of the family history in poor B12 absorption?

In view of the gastritis and Lansoprazole perhaps a retest of her B12 and Folate level could be requested..

I'm not a medically trained person but have had P.A. (a form of B12 deficiency) for more than 45 years.

[Gambit62 Administrator]

the drop in B12 levels - assuming that they are the same units of measurement is potentially significant and she is getting into the area where B12 deficiency is become much more likely.

Serum B12 isn't a gold standard test - it will miss 25% who are B12 deficient and also pick up 5% who aren't - evaluating symptoms is important - folate looks as if it is in range.

PA can run in families.

Have you tried writing to your family pointing out that there is a strong family history of PA, the limitations of serum B12 if used as a single measure and listing symptoms

pernicious-anaemia-society....

and asking for a trial of B12 as recommended in the BCSH guidelines where tests seem inconclusive. Other tests that might help are MMA in relation to B12 deficiency (will be raised if cells don't have enough B12 - but can also be raised by other factors - and IFA as cause of B12 deficiency (though GP needs to be aware that IFA is prone to false negatives 40-60% of time depending on assay method so a negative is a long way from demonstrating that there isn't PA.

Also make GP aware that 25% of people who are B12 deficient don't present with macrocytic anaemia .... and source of information is the BCSH guidelines on diagnosis and treatment of B12 and folate deficiencies which they can access through the BNF but is also available here

onlinelibrary.wiley.com/doi...

[Albie17]

Thank you clivealive and Gambit62 for your replies.

Unfortunately despite her frequent visits to the GP it was only on the last visit that the doctor told her her iron was a bit low and to take a supplement. This is when I started to wonder if it was anything to do with B12 levels. I will make her aware of the PAS website and maybe suggest she writes to our doctor before her next appointment. Thank you both for your help

[Shattered-FedUp]

If I was you and it was one of my daughters, from bitter experience in my own case, I would print off the excellent guidelines on the PAS website for dealing with GPs, but don't hold out much hope & be prepared to have to react yourself as per the advice of the people who administer this forum - I don't know where I'd be without this place!

[Albie17 in reply to Shattered-FedUp]

Thankyou Shattered-FedUp, Honestly I'm so fed up with my GP surgery as I struggle to get by with 3 monthly injections for myself. I used to have them every 6 weeks when I lived in New Zealand which is where I was diagnosed with B12 deficiency, since returning to the UK I have been told 3 monthly was the norm and besides my levels are now high! Told me I am imagining the tingling/numb hands and feet and all the other symptoms. Now my daughter has all of the same signs of B12 deficiency I have to gear myself up for another fight with our GP. I will print out some info from the PAS website and go in with her when she has her appointment.

[Dee215 in reply to Albie17]

Thank you so much for that. I am having exactly the same treatment. It's all psychological. Glad to know I am not alone.

[SusanLMckinney]

It does run in families as my mother, myself and both my sons have pernicious anemia and have to take shots.

[Dee215]

My GP has been telling me I am depressed for years. I am depressed because I feel rubbish all the time. I keep saying this but they gave me the loading dose of B12 then said I can't have any more, it's all psychological. I hope she gets help. Keep fighting for her