Pernicious Anaemia Society
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Help with blood results

Hi these are my 42 yr old brothers blood results . He complains of aches and pains in body . Extreme tiredness at times . Weakness and agitation and low mood . Any help appreciated . Serum vitamin b12 323 ng/l (197-771) serum folate 5.7ug/l (3.9-26.8)

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symptoms could be caused by a myriad of things.

I'm not going to say results rule out B12 or folate being involved but they certainly aren't screaming B12 and folate deficiency

Have other possibilities been ruled out, eg thyroid, diabetes/prediabetes. vitamin D ....?

this is what the BCSH guidelines say on serum folate

The serum folate concentration reflects recent folate status and intake. Most clinical laboratories today measure serum folate by competitive folate binding protein (FBP) assays using chemiluminescence or fluorescence detection systems. Despite considerable variation in performance between assays, using the isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) international reference methods, there was close correlation of the consensus mean in the UK NEQAS surveys (Blackmore et al, 2011). This offers the prospect of harmonization of reference ranges for serum folate assays.

There is no clear consensus on the level of serum folate that indicates deficiency. Conventionally, clinicians have used serum folate lower than 7 nmol/l (3 μg/l) as a guideline because the risk of megaloblastic anaemia greatly increases below this level. However, there is a sizeable ‘indeterminate zone’ [between approximately 7 and 10 nmol/l (3 and 4·5 μg/l)]. Therefore, a low serum folate level should be taken as suggestive of deficiency rather than as a highly sensitive diagnostic test.

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As Gambit62 says, so many symptoms overlap.

I had all your brothers symptoms plus hand tremor, anxiety and pins and needles in feet and numbness in toes and fingers. My B12 was 198 and I started self injecting. Many of the symptoms disappeared--- the anxiety, hand tremor, pins and needles. My balance improved but the fatigue, headaches, coldness and sometimes shortness of breath continued. I had to wait 6 months to see a dr at the respiratory clinic and all tests ( he was very thorough) came back clear. In fact my lung function was so good he seemed surprised I was 62!

Am now on a minimum 8 month wait for a rheumatologist so I went for a private consultation and was diagnosed with fibromyalgia.

I think your brother willl have to push your GP for referrals to get to the root of the problem. Blood tests, ECG, lung Xray ( all standard tests, don't be alarmed) will rule out the obvious and then it will be up to drs to find the cause.

I'd suggest he keeps a diary of symptoms. He meeds to write all of them as I now realise I was only stating the worst 3 ( didn't want to sound moany!)

Might also help to add what everything he eats, drinks, any meds taken for each as this will give the most detailed picture.

It's tiring, it's tedious but he will get to the bottom of the problem.

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06hollyberry, Can I please ask you if B12 injections help your Fibromyalgia as my 40 year old daughter is very bad. Has had to give up work last January. I've asked her to get her B12 tested but her doctor refused and said it wasn't necessary and my daughter has complete faith in her doctor and what he says? I'm furious as it's only a blood test. My mother had PA and I have too. I self inject now thanks to the confidence I got from everyone on here.

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healthunlocked.com/thyroidu...

Today I posted this link and video - Dr Myhill talking about CFS/Fibro. As you will see she also quickly mentions the Thyroid and the inadequate testing - so has her Doc tested her thyroid ? I was diagnosed with fibro in 2000 and auto-immune thyroid - Hashimotos - in 2005. Soon the Fibro was no more.

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I think your daughter should really have B12 checked and intrinsic factor, as PA seems to run in your family. The problem with fibro is that the signs and symptoms are varied, and no 2 people are the same. I was so ill through the summer -- headaches for 3-4 days without let up, so tired I could barely walk, felt constantly nauseous. Other fibro sufferers feel better in hot weather. As soon as the weather broke I began to improve.

I notice that I go about 4-5 weeks between B12 injections and then the pins and needles and a different type of fatigue starts. I can't describe it but to me it feels different. The injection stops the pins and needles and the extra "heavy" feeling fatigue but does nothing for the other fibro symptoms

Drs seem to put everything down to fibromyalgia once a person's had a diagnosis, and the majority don't seem to investigate additional symptoms. It might be worth your daughter having a Blue Horizon test, but really her GP should do one if she says PA runs in the family.

There is a fibromyalgia forum on here that I've found really helpful.

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Thank you 06hollyberry for your reply. We live in Ireland. My daughter has days she can't get up at all then a day she's okay. Always in pain though. It's interesting (for me) to know that B12 doesn't really help with Fibro symptoms as she won't ask her doctor to test her as he's already said no. HE knows best in her mind. I was concerned for her in case B12 helped and she was missing out.

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Low B12 certainly wouldn't help a person with fibro. Some of your daughter's symptoms could possibly be due to a B12 deficiency but have been put down to fibro.

I'm not taking any prescription meds, just OTC painkillers as I need them. I do take an Ayurvedic tablet ( made up for me in Sri Lanka and mailed via a friend) Turmeric and black pepper, selenium and co enzyme Q10. The combination of all of these has really helped. I also eat more protein than I was doing. Going gluten free helped too.

I hope your daughter gets all the help she needs and it's a big advantage having you in her corner.

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No such advantage I'm afraid o6hollyberry. She wants me to butt out of her medical issues as she believes in her doctor, but I'm like a 'dog with a bone' and keep asking her (by email and text only as she won't talk about it) to get tested. I just want to see test results and then I'd be happy. She's not going to change doctors and he refuses to do a B12 test. Why? I really don't know? She has so many symptoms that I used to have that my heart breaks to see her suffering, but what do I know, I'm just 'joe soap'?

I'm hoping to go on holidays to Sri-Lanka next year. It was such a co-incidence to read that you get medication sent to you from there. Isn't it such a small world. Can the Ayurvedic tablet be got over the counter and might it be available to buy in Hong Kong too, as I have a friend living there?

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I'm told that there are lots of Ayurvedic practitioners in Sri Lanka and they're easy to find. They charge only the costs of the herbs, roots etc..they mix for you. Sorry to hear you have such difficulties with your daughter.

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Hi Andypandy. Just a quick thought...has your brother been tested for iron deficiency anaemia? This can cause the symptoms you describe. Perhaps ask GP to test ferritin levels (one of the markers of iron deficiency anaemia) and do a full blood count.

Serum folate is a little on the low side.

Might be a good idea to check against the B12 deficiency symptom checklist (in second PAS pinned post) to see if he has any other symptoms of B12 deficiency - although B12 level is in range, it's not a reliable marker of deficiency and his GP should be looking at clinical symptoms of deficiency (if present)...especially if other causes for symptoms have been ruled out.

If in doubt, MMA and homocysteine blood tests might help clarify (though there are other causes for these being raised).

Best not to take any B12 supplements as these will skew blood test results and make diagnosis of B12 deficiency very difficult - if this is indeed the cause.

As gambit says, the symptoms you describe can have many potential causes so the best idea is for your brother to see his GP, who should want to start some basic medical checks and blood tests to try and find out what's going on (hence why I suggest no supplements).

Good luck. Hope you find some answers soon 👍

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The B12 and Folate is not too low but you can talk to gp as levels are the higher end could only help.

You should also get tested for Iron and Vit D, Thyroid, diabetes as these are standard tests and you could get similar symptoms.

These above mentioned should all be in good range, which can take some time but is not a problem.

If all the standard tests are ok then your Gp should consider further investigation to get to the cause.

A good diet and some daily exercise can help a lot if you can manage.

There's a lot of people here to give you better advice so you're on the right track.

Wish your bro well.

🙂

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Sorry forgot to mention to get a FULL blood test and then post results if you can which will be of more help.

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