Testing for pernicious anaemia

[SianT1]

Recommended to come here by a helpful thyroid uk member. Looking for testing for pernicious anaemia due to consistently low vits and mins and symptoms. Not feeling well taking 210mg ferrous fumarate once a day for iron deficiency since Jan 2017 and 5mg folic acid for folate deficiency since Nov 2016 thanks

May 2017

Ferritin 51 (30 - 400)

Folate 2.6 (4.6 - 18.7)

Vitamin B12 228 (190 - 900)

Vitamin D 44.7 (25 - 50 deficiency)

[clivealive Forum Support]

Hi SianT1 despite your B12 level probably being flagged as "normal" you are still deficient on Folate and low on Ferritin and Vitamin D so I'm a bit surprised that your doctor isn't supplementing your B12 especially as, if you have thyroid problems this may put you at risk of developing a B12 deficiency .

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.

If you have neurological symptoms the BSH guidelines say "In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment".

google.co.uk/url?sa=t&rct=j...

Make a list of your symptoms and present this to your doctor and ask him to treat you according to your symptoms and (perhaps) even start you on loading doses "until there is no further improvement" according to the N.I.C.E guidelines below. Click on the link, then on "Scenario: Management" and scroll down to "Treatment for B12 deficiency"

google.co.uk/url?sa=t&rct=j...

Whether or not you have P.A. can only be determined by having your Intrinsic Factor tested for antibodies. What is important is that if you do have neurological symptoms treatment should be started as soon as possible,

1.2 Neurological Symptoms

The neurological symptoms of vitamin B12 deficiency may include:

 Numbness and tingling of the arms and more commonly the legs

 Difficulty walking

 Loss of balance

 Hands feel gloved with loss of sensitivity

 Loss of vibration sense, having to look down to see where you are walking

 Unable to close your eyes and stand on one foot

 Night vision

 Memory loss

 Disorientation

 Dementia

 Extreme mood changes

 Short term memory loss

Some experience many of these symptoms and some none of them. It depends on how quickly the PA is treated and on how well managed it is.

I'm not a medically trained person but I've had P.A. for over 45 years and I wish you well.

[fbirder]

Your folate is 2.6 yet you're taking 5000 ug a day (25 times the recommended amount)! How does your doctor explain that?

[SianT1 in reply to fbirder]

Hi I have asked the GP to explain this and why my folate levels are low in the first place and she said it just happens. I am speaking to a new GP next week to ask for more investigations to be done including coeliac

[Gambit62 Administrator in reply to SianT1]

other absorption problems would include PA, h pylori and a whole raft of drug interactions and probably pursuing an absorption problem is the best tack to take at this point.

Other things to make sure your GP is aware of

a) serum B12 isn't a gold standard test and will miss 25% of people who are B12 deficient (and also pick up 5% who aren't) if taken as a single measure.

b) 25% of people who are B12 deficient don't present with macrocytosis when they first present (ie it isn't a defining characteristic)

c) symptoms are an important part of evaluating treatment of B12 deficiency and treatment should be on the basis of symptoms if there is a discordance - particularly if there is neurological involvement.

source: BCSH guidelines on diagnosis and treatment of B12 deficiency which your GP can access through the BNF though it can also be accessed here

onlinelibrary.wiley.com/doi...

Please note that although this forum has anaemia in the title it is actually about one specific absorption problem that leads to a B12 deficiency and a type of anaemia called macrocytosis - macrocytosis will also result from folate deficiency. B12 deficiency tends to develop slowly over years or even decades. folate deficiency develops much more quickly. Symptoms overlap considerably and overlap with other conditions including iron deficiency, thyroid problems, diabetes and several other conditions which can make evaluating on the basis of symptoms rather difficult.

if you have an autoimmune condition then it makes you statistically more likely to have another autoimmune condition.