Pernicious Anaemia Society
15,506 members10,917 posts

B12 and crp

Can anyone advise me please.

I have just learnt this week of my blood results.

B12 is 115

Crp is 76.

I'm feeling generally quite awful and have done for 3 years, mainly mind disturbances, disconnection and tremor.

I have to wait for 8 days to have a review regarding my blood results.

I'm clueless to what this means.

I've had other results but upon looking online these 2 above appear to be the most worrisome.

22 Replies
oldestnewest

Hi Spin5. Are you able to provide the reference ranges (the two figures after the result). Its not possible to interpret results properly without those.

Also - it would be useful if you could post any results you have as often it's where the result sits within the reference range that's meaningful, not just being within it. (FBC, Folate, Ferritn would be particularly useful if you have them).

A bit more detail about any symptoms and any other medical conditions you have would also be helpful and enable members to give you better advice.

👍

1 like
Reply

If you are based in the UK and the results are from your GP you need to go back and demand that they treat you in accordance with the BCSH guidelines - which means loading shots for B12. CRP is a protein marker that's raised if you have infections ... and could be raised as a consequence of various process not working properly because they are not getting enough B12 but is also going to be responsive to other things.

You need to draw your GPs attention to the following:

a) your levels are very low. Whilst serum B12 isn't a gold standard test and if used as a single marker will pick up 5% of people who are B12 deficient - but will also miss 25% who are - so evaluating symptoms is important

b) your level is well below the normal range and you are highly symptomatic making it highly unlikely that you aren't B12 deficient

c) you have neurological symptoms - the tremors and the mind disturbances, then treatment should not be delayed. There is a slightly different and more aggressive regime for treating B12 with neurological symptoms) which would mean loading shots 3x weekly until your symptoms stop improving (so would be good to put together a list of your symptoms so you can monitor them) with a review at 3 weeks - then maintenance shots every 2 months.

(no neurological involvement = 6 loading doses over 2 weeks followed by maintenance every 3 months.

d) 25% of people who are B12 deficient do not present initially with macrocytosis - so lack of macrocytosis cannot be used to rule out B12 deficiency

refer your GP to the BCSH guidelines for diagnosis and treatment of cobalamin and folate deficiencies (which they can access through the BNF) if they want to check the above.

They can also be accessed here

onlinelibrary.wiley.com/doi...

you can find a list of symptoms here

pernicious-anaemia-society....

If you can take someone with you to support you and present facts etc.

If you aren't based in the UK there are different protocols for treating B12 deficiency, which can be quite difficult - but where-ever you are you are very ill and need to be treated NOW not in another 8 weeks time.

The mechanism for absorbing B12 is very specialised and the body also stores quite significant amounts of b12 in the liver and then releases them as needed using the same mechanism as is used for absorbing B12 from your diet - this means that a full blown deficiency can take years and even decades to develop, but once it really starts to take hold it tends to snowball - so when you are looking at the symptoms please bear in mind stuff that crept up slowly a lot longer ago than 3 years may actually be related to what is happening at the moment.

B12 is only found in animal products (meat/fish/dairy/eggs) so being a long term vegan can lead to deficiency unless you supplement with B12 but the amount of B12 needed if you don't have an absorption problem is very small - 2.5mcg a day so a dietary deficiency is quite rare.

3 likes
Reply

Thank you both for taking the time to reply.

I've been unwell for 3 years, basically after my 3rd child.

I'd developed crippling anxiety (which is bizarrely out of character)

I self diagnosed that I'd had anxiety disorder but this last year I've succumb to feeling very unlike myself.

Symptoms

Internal tremor, mind racing, shaking, aches and pains, itching, cold extremities, brain zaps at night, complete dusaassuation from the world to the poInt I thought I was going mad and was at risk of hurting my child. I finally went to the docs and was put on ssri, 20mg.

After a month my anxiety appeared to have settled but the internal tremor remains. I have pain but I don't care about that I only care about my sanity.

If pushed for a blood test on Monday gone. (U.K.)

My results are as follows.

B12- 115,

Folate 5.4

Tsh 2.76

Serium albumin 45

Serium alkaline phostate 52

Serium alanine 21

Crp 76

Total bilbumin + protein 9

I've called repeatedly for a sooner appointment but Wednesday is booked 30th Aug for a review to discuss results.

Sorry 8 days not weeks.

Thank you for taking the time.

Reply

Also I only eat beef or chicken. Not a vegan and plenty of vegetables.

I have been self medication with wine to get to sleep this last year.

I'm in a mess.

1 like
Reply

alcohol not the best thing to self medicate with - whilst it will get you to sleep it will also result in waking up earlier.

really hope you get treatment promptly and start to feel the benefits soon.

1 like
Reply

it would help if you could manage to get a proper print off of the results at some point - they will come with a 'normal range' which will be in brackets after them - which is what Foggyme was asking for.

There are different units that can be used for measuring most items so quoting just numbers out of context is a bit difficult but your B12 results are low regardless of what units it was measured in.

Ranges can also vary with different machines and assay methods.

8 days is a lot better than 8 weeks :)

Suggest that you do try and take someone with you to help you with the communications - hope that it goes well - but do check that they put you on the treatment with neurological symptoms rather than just the normal treatment

2 likes
Reply

Thank you. Sorry for typos above.

I do not have the printout as yet. Only a call from the surgery on Tuesday, day after bloods were taken to say you need to come in as b12 is a little on the low side.

I have called 3 times this week asking for the rest of my blood and they were reluctant as wanted not to wait for review. 😡

I called this evening and politely demanded them.

Thank you for your advice.

Reply

had to laugh at the 'little low' :)

1 like
Reply

Her exact words. 😂I'm entirely clueless but advised by my sister that it is extremely low. She is b12 deficient and has hassimoto disease. (please excuse spelling)

1 like
Reply

Was just reading you post and it's only through this forum that I might be low on B12, I suffered with numerous stomach problems and had internal bleeding last year, which was clamped off, treated for the h pylori and have been on omeprazole ever since, but I never asked for a crp test when I had my blood checked for my initial diabetes test, it's by sheer chance that I asked for a B12 report, now I've been diagnosed with a skin condition for several years hydragenitus would this have shown any markers on my bloods? It I gets so confusing getting one blood test but then maybe having to ask for another test, I have a couple of cysts on my adrenal gland, so I don't know if the removal of these would then stop this terrible skin issues as I believe it releases testosterone, I'm a male in my mid fifties and I'm getting that many antibiotics just recently don't even know if these can be affected by non absorption symptoms, just finished a course of injections and been told I don't need to go back until November now, as I still have some absorption, it was a strange discussion with the nurse who administered the injection as I informed her that general anaesthetics can cause the B12 problems and also taking long term omeprazole can cause these problems, she had never come across this story, I'm very surprised that folk who have stomach issues or had quite a few general anaesthetics are not tested routinely, and hopefully this could solve any other problems that might arise from not getting the right treatment in time, and finally I've got pherieral neuropathy all classic symptoms of low B12, and taking long pregabilin, so all very confusing how various symptoms can cause more symptoms along the way, thanks

1 like
Reply

Hi Spin5,

You've already had some very good advice - and there is plenty on here and some very experienced people to help you find a way through the difficulties.

Just to throw my limited experience from having a recent result of 118ng/L:

The low cut off range in my area was 140 (which is probably too low) so I was flagged as deficient, but the GPs I spoke to seemed not to be fully aware of the latest guidelines - the BCSH (now called BSH - British Society for Haematology) guidelines are the most thorough - and in particular the need for a longer initial loading dose where there are neurological symptoms.

I had to push to get more, and found the nurse giving them the most open to discussion, but be prepared to print out the guidelines and take them with you, with relevant bits highlighted. Don't be frightened to make your case - you may find it easier to do so in writing, so that everything is clear and also is recorded on your records.

Some areas seem to have different, out of date, guidelines in place so if the GP does not wish to follow the ones above it is worth asking what they are basing their decision on, as there seems to be a lack of up to date knowledge in some areas.

If you are not feeling as if you are getting a good response, you could consider requesting a referral, either to a neurologist for the symptoms, or a haematologist, who will be best placed to work out what your various blood results mean (they can be quite complicated when there are multiple issues at play).

If your Iron (ferrite) levels haven't been tested it may be worth looking at those also, as the symptoms of deficiency of that can overlap with B12 and/or folate.

The GP will most likely also consider what's called an Intrinsic Factor Antibody Test. This looks to see if the antibodies are present, which if so would lead to a diagnosis for Pernicious Anaemia. However, this test is not that accurate (40-60%), so a negative result is not a reason to stop treatment - the treatment is actually the same regardless, partly because the test is known to be inaccurate, so just be aware in advance (It's a useful diagnosis tool, but not a reason to withhold treatment)

My IFAB test came back negative, but I'm due to have the 10th of my initial loading doses tomorrow and have finally started to notice some improvement on the memory/forgetful/finger numbness, although I still think there is lots of room for improvement.

Hopefully you will find an even quicker improvement and will get some comfort from the symptoms, which can be very debilitating.

Feel free to keep asking questions - the forum is a wealth of knowledge from many different experiences and has been a great help to me.

Gavin

2 likes
Reply

I'm so sorry you are feeling so desperately unwell and I despair that, in spite of your low B12 and history of feeling increasingly ill since your last pregnancy, you are not being given the urgent support and treatment with injections that are clearly needed.

I'm sure you already know that pregnancy creates high demands on B12, as well as other vitamins, and is involved in building DNA. The excellent book, "Could it be B12? An Epidemic of Misdiagnoses", by Sally Pachlok, has extensive information on low levels in pregnancy and the knock on effects it can have, e,g, nitrous oxide (gas and air or anaesthetic) may inactivate vitamin B12, if levels are already low - this can cause many of the symptoms you describe:

"B12 is critical before conception, during pregnancy and during breast feeding. A Serum B12 falling in the 'grey zone' is not adequate for prenatal or postnatal care. Moreover, prenatal vitamins do not contain enough B12 to correct a deficiency or beginning deficiency, and a growing foetus in the womb needs plentiful amounts of B12, which pregnancy can deplete (see chapter 12)".

..............

This link gives templates for writing to your GP as well as other information on the importance of good levels of B12, and the serious consequences if you're not treated without delay. Taking someone with you for extra support is a very good idea, both as a witness and to ensure you are listened to :

b12deficiency.info/b12-writ...

bmj.com/content/349/bmj.g5226

bmjopen.bmj.com/content/6/8...

"Conclusions The UK Recommended Nutrient Intakes (RNIs) for B12 intake should be increased for women of childbearing age with intakes of around 5–7 μg/day likely to be associated with stable biomarker levels. B12 levels should also be measured in women preconceptionally or in early pregnancy given the high rates of deficiency"

............

Very best wishes For better treatment Spin5

PS In the meantime, you may find, as I did, this really interesting:

westonaprice.org/health-top...

Reply

PS

Your TSH looks a bit high - are you on thyroid medication? It may be as well to also ask for T4, T3 and antibodies to be tested. Hashimoto's and PA/B12 deficiency are often interconnected:

bbc.co.uk/news/health-38895877

A very scientific link re. how pregnancy affects the thyroid :

journal.frontiersin.org/art...

Reply

Polaris

Could you re-post your link please, re westonaprice.org etc

All I can see is "westonaprice.org/health-top..." and it's not a hyperlink so a bit stumped.

Many thanks

Reply

I've found this article, which I suspect is the one Polaris was hoping to link to. I found it very interesting reading ;) Thanks Polaris

westonaprice.org/health-top...

If this isn't the same article, at least it's an interesting one ;)

Reply

Not the same article JMN but a really good one I hadn't seen before, so thank you! Might be worth you posting separately, as very interesting.

Have edited the link above - fascinating reading about the dentist, Weston Price, and his travels/research into traditional diets of many countries, which far exceed the vitamins and minerals and nutrition generally of Western diets now. Also how they instinctively knew the importance of special attention to this before, during pregnancy, and to the mother and growing child after birth.

1 like
Reply

Many thanks, Polaris

Reply

Thank you all for your advice. I've been to the doctors today and will be having my first loading dose today.

I have a print out of my blood results and turns out my CRP is 1.0 so the receptionist gave me the wrong info at the start of the week.

My results all appear normal, with the exception of B12.

She said I am not anemic and all other results are fine.

Reply

How do I post a pic of my results?

I'd rather know through this forum if everything is normal. As from reading above I know the doctor can be giving us misleading advice.

Reply

I can't add a copy of the print out so shall just mention the results that have come back as above or below range.

Mean cell volume 102.0fl [83.0-101.0]

Mean cell haemoglobin 34.8pg [27.0-32.0]

Urea and electrolytes test:-

Serum sodium 134 mmold/L [135.0-145.0]

Serium creatinine 51 umol/L [62.0-124.0]

Any help understanding these or to know if it warrants further investigation would be greatly appreciated.

Reply

Your Mean cell volume (MCV) results indicate you have macrocytic red blood cells ie they are bigger than they should be. Your mean cell haemoglobin is above range too which is often found when you also have raised MCV as this is a measure that is linked to your red blood cells (which are abnormal at the moment!). labtestsonline.org.uk/under...

Both of these are often seen with a B12 deficiency so these should hopefully gradually sort themselves out (as you will now have B12 available!) as your red blood cells are naturally replaced (takes ~4 months).

I'm not a medic so it may be an idea to discuss your results with your doctor as they will be able to put them into context especially if you have any other medical issues or worries.

Sodium is something that is very closely controlled by the body but this is only just out of range so it may be something as simple as having diarrhoea or drinking loads of water could have affected this. Your GP may want to keep an eye on this in any future tests though as sodium is very important to the body and it getting very low can be very bad. labtestsonline.org.uk/under...

Creatinine is closely related to muscle mass as it is a waste product from muscles. labtestsonline.org.uk/under...

Reply

Thank you very much for your reply.

The doctor was quite happy with starting the loading jabs but said little else going forward. I should have asked questions about relevant supplements I should take, but didn't. To be frank, I'm so relieved, I now know there is a medical deficiency that may have contributed or caused all this strangeness and it wasn't me being a mental case.

Reply

You may also like...