How do I know if I have PA?

[Swainy]

Just been advised that I need b12 injections. My levels are b12 128 ng/l and holotranscobalamin concentrate 22 pmol/L. Is this pa? Have added rest of test results from test run so far.

[clivealive Forum Support]

Hi Swainy there is a specific test for Pernicious Anaemia which checks for Intrinsic Factor Antibodies (IFA).

Intrinsic Factor is produced in the stomach lining and it is essential to "grab hold" of the B12 from your food (meat, fish, eggs, poultry and dairy produce) as it travels down through the digestive system.

What sort of diet do you have?

At the moment you have a diagnosis of Vitamin B12 Deficiency and there can be several causes of that.

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Women with a history of infertility or multiple miscarriages

.

Do you "see yourself" in any of the above people?

What treatment has your doctor prescribed?

Your Serum Folate level is quite low and may need supplementing as it and B12 help your iron to function properly and make red blood cells

I am not a medically trained person but have had P.A. for more than 45 years.

I wish you well but please come back if you have any more questions as there are others on here who will be able to give you good advice.

[Swainy in reply to clivealive]

Hi

I have been a vegetarian some I was 15 now46. I have vilitigo and have had 3 colonoscopies in the last 2 1/2 years. Had 3 polyps removed largest of these was 20mm. These were removed whilst I was on gas and air. Thank you for your reply

[clivealive Forum Support in reply to Swainy]

Then your B12 deficiency may be down to your diet although your low Folate is a bit surprising given that you are vegetarian.

Rich sources of folate include spinach, dark leafy greens, asparagus, turnip, beets, and mustard greens, Brussels sprouts, lima beans, soybeans, beef liver, brewer's yeast, root vegetables, whole grains, wheat germ, bulgur wheat, kidney beans, white beans, salmon, orange juice, avocado, and milk.

It can also be found fortified into many breakfast cereals as folic acid.

[Swainy in reply to clivealive]

Thank you for your response. I eat most of what's on the list already which is what surprised me to.

[clivealive Forum Support in reply to Swainy]

Then as Gambit62 says you probably have an absorption problem and should discuss this with your GP.

[Gambit62 Administrator]

Your blood tests showed that you had a B12 deficiency - they didn't give any information on the cause.

The fact that you have had injections implies that your GP has ruled out diet as a cause, meaning that you have an absorption problem. PA is one possible absorption problem.

B12 is only found in animal products - so a vegan is at risk if they don't supplement. a vegetarian is at risk if they eat very little egg or dairy ... and anyone who eats very little meat/fish/dairy/egg is also at risk of a dietary deficiency but it is quite rate in the last two cases because the amounts of B12 you need daily are very small.

The most likely cause of a deficiency is an absorption problem. Because the body stores quite good quantities of B12 in the liver - releasing them to be reabsorbed in the ileum as required - absorption problems can take years and even decades to turn into full blown deficiencies.

Measuring levels of B12 in blood is a reasonably good way of identifying an absorption problem (which is what holo-T and serum B12 tests do). However, it won't tell you what the cause of the problem is.

PA is the most likely cause but the test currently available can be very inconclusive, eg a negative on IFA is a long way from saying you don't have PA.

other possibilities include coeliacs, crohn's, gastric surgery affecting the ileum, lowered stomach acidity, drug interactions, h pylori.

h pylori is a treatable cause so may not need injections for life

- drug interactions may be more problematic and could also be drugs that are dealing with symptoms of B12 deficiency rather than addressing the route cause, ie may be secondary to the real cause.

generally unless the cause of absorption is treatable, you will need regular maintenance doses maintain healthy B12 levels in future.

[bluetit42]

my folate was 2.5 was given folate from gp but now but from amazon methylfolate made from natural ingredients.

[Swainy in reply to bluetit42]

Thank you for your reply. My gp didn't seem that bothered about folate level but will see if there is any change when I have next blood test in a couple of weeks. I will have a look on Amazon though. Thanks