Advice on B12 levels following on from blood tests

[helbels1972]

Hi, I was referred over to this forum from the very helpful people on the thyroid forums. I had major surgery earlier in the year, including a blood transfusion, and since then have been struggling a bit with hair loss and inability to lose weight despite diet and exercise (which is why I suspected thyroid issues). I got my bloods tested, and have posted my results below. You'll see that my Vitamin B12 is low, and so is my Vitamin D. Ferritin isn't great either, although I've been on Ferrous Sulphate 200mg daily for four months since my surgery.

Just wondered what advice you guys have for getting my B12 levels up? Unfortunately I have no way of knowing if they were low before the surgery, or whether this is just a result of it. It was suggested that I might want to consider Pernicious Anaemia as my iron levels are low too, although I don't know anything about it. All advice and comments gratefully received.

Blood results:

Vitamin B12 200 (pg/ml 197-771)

Folate (serum) 10.1 (ug/L >2.9)

Ferritin 54 (ug/L 13-150)

C reactive protein 3.5 (mg/L <5.0)

Total Thyroxine (T4) 89 (nmol/L 59 - 154)

TSH 1.76 (mIU/L 0.27 - 4.2)

Free Thyroxine 15.3 (pmol/L 12.0 - 22.0)

Free T3 4.1 (pmol/L 3.1 - 6.8)

25 OH Vitamin D 51 (nmol/L 50 - 200)

Thyroglobulin Antibody 17.0 (IU/ml 0-115)

Thyroid Peroxidase Antibodies 24.2 (IU/ml 0-34)

[Gambit62 Administrator]

PA is one particular absorption problem that will lead to low B12 - it can also affect iron absorption.

Really you need to get GP to recognise that you have a B12 absorption problem and start treating you with injections per BCSH guidelines (which they can access through the BNF). They may also refer to NICE guidelines but the BCSH guidelines are a lot clearer.

serum B12 is a difficult test - if used as a single marker it will miss 25% of people who are deficient but also pick up 5% who aren't so looking at symptoms is important

pernicious-anaemia-society....

recommendation is to treat on basis of symptoms if there is a discrepancy between these and the results - and your result is low in range making the chance that you are one of the 25% quite high.

macrocytosis is present in 75% of people who are B12 deficient - its a common symptom but not a defining characteristic and if you are having problems with iron absorption as well could easily be masked by microcytosis from iron anaemia.

Other possible absorption problems are: coeliacs, h pylori infection, drug interactions and a load of others.

if tests were private GP may want to repeat them

[helbels1972 in reply to Gambit62]

Thanks - I don't really have any symptoms of PA apart from fatigue. I've booked an appointment with my GP for two weeks time (earliest I could get!) so we'll see what he says then.

[Gambit62 Administrator in reply to helbels1972]

in which case the low may not necessarily be significant.

though you do mention hair loss above, which could be a symptom - but can also be a symptom of iron deficiency and thyroid if you have a thyroid problem. I'd suggest ruling out other possibilities with GP and then coming back to B12 if the symptoms persist.

[clivealive Forum Support]

You B12 and Folate will probably be flagged as "Normal" although the B12 is really "bumping along the bottom of the range.

Do you have any neurological symptoms associated with a B12 deficiency?

Symptoms of B12 deficiency tend to develop slowly and may not be recognised immediately. As the condition worsens, common symptoms include:

Weakness and fatigue

Light-headedness and dizziness

Palpitations and rapid heartbeat

Shortness of breath

A sore tongue that has a red, beefy appearance

Nausea or poor appetite

Weight loss

Diarrhoea

Yellowish tinge to the skin and eyes

If low levels of B12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms:

Numbness and tingling in the hands and feet

Difficulty walking

Muscle weakness

Irritability

Memory loss

Dementia

Depression

Psychosis

Having thyroid problems may put you at risk of developing a B12 deficiency.

I am not a medically trained person.

[helbels1972 in reply to clivealive]

Thanks for your reply. I don't really have any of those symptoms apart from fatigue - which could just as easily be caused by the iron I guess.