Pernicious Anaemia Society
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Blood results

Hi - I’ve been directed here from the Thyroid community, based on some recent bloods. I’m now managing my hypo with T3, but I also have the following results (lab ranges in brackets) which various Thyroid community members have flagged as low.

Any thoughts received with thanks! X

Vitamin B12 - 260 (140-724)

Serum Folate - 6.07 (2.9 - 50)

CRP high Sensitivity - 6.2 (0-5)

Ferritin - 74 (13-150)

Diet-wise I’m completely grain free. I have low appetite but retain about a stone of extra weight. I have varied autoimmune conditions, largely under control, but am struggling with memory issues and tiredness. Also, muscle weakness and numbness/tingling in arms/hands.

In the past I’ve had metformin and lansoprazole, but all symptoms alleviated by grain free. Turns out acid is low not high!

4 Replies

why were you taking metformin - was it for diabetes or something else?

Both metformin and lasoprazole can impact on the absorption of B12.

B12 isn't a gold standard test - it will miss 25% of people who are B12 deficient but would also pick up 5% who aren't if you use it as a single indicator - your results are to the bottom of the range so that increases the likelihood that you could be one of the 25%

Could you provide units for the folate test?

Ferritin looks good but it's only one marker for iron.

Tests that can help clarify with B12 are MMA and homocysteine - but both can be raised by other things so they need to be done in context.

Did you have a full blood count done?


Hi - and thanks for responding!

Metformin was for PCOS. Since being grain free I’m now completely asymptomatic and haven’t been on any drugs since 2013.

Folate units were ug/l

This was thyroid ultra from medichecks. I had full blood count a year ago.


coeliac is a possible cause of B12 absorption problems but will be difficult to test for that if you are gluten free.

Did the full blood count throw anything odd up - not that one that old is really any indication of what may be going on at the moment. One classic symptom of B12 deficiency is a type of anaemia called macrocytic anaemia - also a symptom of folate deficiency. However, its also not present in 25% of people who are B12 deficient when they first present.

This is what the BCSH guidelines say about serum folate test results

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.

on the basis of the above your folate levels look fine and unlikely to be a problem.

Had missed the comment on low stomach acidity - that could certainly cause B12 absorption problems as well.

You could try talking to your GP about the limitations of serum B12 test and see if, in light of your symptoms (and the low stomach acidity as having a negative impact on your ability to absorb B12), they will consider a therapeutic trial of B12 as recommended by the BCSH guidelines, or look at MMA as a supplementary test to clarify if enough B12 is getting through to your cells.


Thank you so much - really appreciated. I’m fairly certain I am coeliac, and that it manifested at a very young age. However, as you say, I’m not willing to test as any exposure to gluten or similar proteins have an immediate and highly detrimental effect.

I’ve not seen a GP for almost four years. I became very disillusioned with myriad misdiagnoses and unnecessary prescriptions, so see a functional doc instead. With her tomorrow so will ask! :)

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