Pernicious Anaemia Society
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Hello

Been directed here by the helpful people on the Thyroid UK forum, these are my girlfriend's results for B12 and folate. Her iron deficiency is still by the looks of things unresolved? Thanks

(Folic acid prescribed after this result)

Folate 2.38 (2.50 - 19.50)

(No supplements for B12)

Vitamin B12 200 (190 - 900)

(Taking 1 ferrous fumarate tablet per day for iron deficiency diagnosed in 2013)

Ferritin 46 (30 - 400)

MCV 76.2 (80 - 98)

MCHC 374 (310 - 350)

4 Replies
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Hi ADC79 what symptoms does your young lady have? She is Folate deficient and her B12 is barely "bumping along the bottom" of the range although it is probably flagged as "Normal"

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

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.

Symptoms of a folate deficiency can include:

symptoms related to anaemia

reduced sense of taste

diarrhoea

numbness and tingling in the feet and hands

muscle weakness

depression

Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.

Were the tests done privately or on the NHS? If the latter, what did her doctor say?

I am not a medically trained person but there are others on here who will be able to give you good advice.

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Thanks for reply, out of the symptoms she has:

Weakness and fatigue

Light-headedness and dizziness - worse around periods. She is prone to blood rushes around this time which we are guessing is a result of her losing iron.

Palpitations and rapid heartbeat

Shortness of breath

She doesn't have a sore tongue but she has noticed a sore and rough area on her hard palate

Nausea and poor appetite

Weight loss

Diarrhoea

Yellowish tinge to the skin and eyes

Numbness and tingling in the hands and feet

Difficulty walking

Muscle weakness

Irritability

Memory loss

Dementia

Depression

Psychosis

Reduced sense of taste

The tests were done on the NHS, by the sounds of things the GP should have done something?

Reply

Your girlfriend's doctor should be treating her symptoms not just looking at the computer screen.

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". (See clause 4 in the summary)

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

Make a list of her symptoms and present this to herdoctor and ask him to treat her according to her symptoms and (perhaps) even start her 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...

If possible have someone (yourself perhaps?) go with her who can validate her neurological symptoms as the doctor is less likely to pooh pooh them in front of a witness.

I am not saying that this is an easy thing to do but ask her to try to stay calm, write out what she wants to say and keep to the script and be confident that she is "in the right" and her facts are correct.

I wish you both well.

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Looks like your girlfriend has multiple vitamin and mineral deficiencies - GP should be looking for an absorption problem as well a treating the deficiencies.

although B12 is in range it is low and given the folate levels and absorption problem and being highly symptomatic the probability is that she is one of the 25% that will be missed if the test is taken as a single measure. She should be started on B12 injections and then start taking folate the next day.

She doesn't show any signs of macrocytic anaemia in the above results - possibly because it is being masked by the iron deficiency. Macrocytic anaemia (larger rounder red blood cells) isn't present in 25% of people presenting with a B12 deficiency.

link to BCSH guidelines on diagnosis and treatment of cobalamin and folate deficiencies

onlinelibrary.wiley.com/doi...

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