New to the group- advice please?

[Tiff35]

Hi all

I have been recommended by a fellow member in the thyroid group to find out some more information about pernicious Anaemia and to ask you kindly for your advice following my blood results as to whether it might be the case?

Abit of background: I am a 35 yr old female (no previous medical conditions) who has two little ones under two my last baby born 6 months ago. Since my last baby was born I have been feeling pretty bad with light headedness, fatigue, foggy brain, pain in joints (particularly hands) pins and needles.

GP did some blood tests and I am hypothyroid with hashimos (anti bodies were in 500s) I am also very low in ferritin (5) last checked 6 weeks ago which I am currently taking two 200mg ferrous sulphate tablets for a day. My haemaglobin levels were borderline at 11.6

I have started lyvothyroxine (3 days ago) for thyroid at lowest dose 25umg to be tested in 6 weeks time.

I also had some vit tests completed last week and although within range (therefore GP not concerned) they are lower end so feel maybe this might be contributing to some of my symptoms?

Folate was 3.3 (abnormal range starts below 3.1)

B12 was 205 (abnormal range below 187)

I was not tested for vit D and since reading about hashimos will probably get this done privately.

Do you think my blood results could be pernicious Anaemia? Should I mention it to my GP?

I would really like to supplement my b12 and folate please could somebody advise how I could do this myself?

Thank you so much for your time if you have read his far!

[Gambit62 Administrator]

assuming that your diet is good in folate and B12 - the low levels combined with the low ferritin could be indicative of an absorption problem -

has anything been done about trying to track down what was causing the low iron in terms of absorption - as I presume a bleed had been ruled out?

Serum B12 isn't a gold standard test - there is so much variation in the normal population that using it as a single indicator of B12 deficiency will result in missing 25% of those who are B12 deficient (but also pick up 5% who aren't - so symptoms are important. Using macrocytosis - enlarged rounder red blood cells as an single indicator is also problematic as it isn't present in 25% of people presenting with B12 deficiency. Added to this that microcytic anaemia (caused by iron deficiency) makes your blood cells smaller and interpreting a full blood count gets quite difficult - though the likelihood is that the RDW (red blood cell distribution width) will be raised reflecting a mix of macrocytic and microcytic anaemia.

BCSH standards for diagnosis and treatment of cobalamin and folate deficiencies recommend treating on the basis of clinical presentation if there is a discordance between test results and clinical presentation. This is particularly stressed if you have neurological issues - the tingling/numbness that you mention.

Your GP can access the BCSH guidelines through the BNF but they are also available here

onlinelibrary.wiley.com/doi...

I realise that evaluating symptoms is going to be really difficult given the thyroid problems and the overlap with thyroid symptoms

suggest you share the above with your GP and ask for tests in relation to absorption problems which would include PA and coeliacs

Please also make sure your GP is aware of the limitations of the IFA test for PA - it produces false negatives 40-60% of the time depending on the assay method so whilst a positive is good as an indicator that you have PA a negative result is a long way from demonstrating that you don't have PA.

[Tiff35 in reply to Gambit62]

Thank you so much for your detailed advice. I will certainly try to be proactive. To answer your question i was not given any reason for the Anaemia. I assumed it would be post baby related but maybe not. I have always been very anaemic when pregnant despite supplements and having a healthy diet.

[Gambit62 Administrator in reply to Tiff35]

in which case I would definitely push the idea that you have an absorption problem and trying to identify what it could be as different absorption problems can have different health consequences so it's a good idea to be aware of them so you can monitor for them.