Can somebody help me understand my results please?

[Gempep]

Hi all,

I've had some recent blood tests to check my b12 and folate levels. I had this test last week and got a letter that I need another blood test to check the "red cell folate" so I went back today. Whilst there I asked for a print out of my last results. Seems they only checked a few so here they are...

serum vit b12 level - 313 ng/l (180-900)

Serum folate level - 2.1 ng/ml (3-17)

What does this mean?

I'm awaiting the results of the red cell folate test as only had it today.

Main symptoms are tiredness, lack of energy, pins and needles in my calfs and feet, look pale, anxiety has effected me for months now , shortness of breath, very dry mouth and sore tongue (as dry). I am a 30 yr old female. Also epileptic and have ibs. Not sure if they are relevant.

Thank you in advance

[Gambit62 Administrator]

there are two possible tests for folate - red cell folate and serum folate - serum folate is the most common one and given that your test result above clearly shows that you are folate deficient not sure why the feel a red cell follate test is necessary but ...

the symptoms of folate deficiency and B12 deficiency are pretty similar because the two are used together for a lot of key processes. one symptom of both is macrocytosis - in which your red blood cells are larger and rounder than normal. This means they are less efficient at picking up and transferring oxygen to cells that need them so this may be part of what is causing your symptoms.

Next question would be about diet and whether you eat enough fresh fruit and veg to check that the deficiency isn't dietary. If it isn't dietary then it is probably an absorption problem - PA being one possibility.

Your B12 levels above look quite good on the face of it and if your symptoms came on quite quickly a few months ago then its most likely that your problem isn't B12 ... though if your folate is caused by absorption rather than diet it may just be a question of time before B12 is a problem for you.

folate deficiency is quite easy to correct using oral tablets - and you can get folic acid from a supermarket - though your GP may well prescribe some very high dose tablets for a month or so.

may be worth discussing your meds with your GP just in case there is anything there that affects absorption

[Gempep in reply to Gambit62]

Thank you so much for replying.

The doctors haven't really explained anything to me, in fact it was me who requested my b12 checking as my pharmacist said my epilepsy meds can cause the deficiency.

In regard to my diet I'd say it was great to be honest, I mainly eat the foods that it tells you to eat such as meats, I love kale green beans cabbage and broccoli and have at least 2 of them a day. Fruits are my snacks, don't get me wrong I do like the occasional rubbish food but I'd say my diet is traditional English foods, potatos meat veg etc.

In the past I was told my red blood cells were larger than normal but nothing came of it. There is a link with my meds to folic acid as I was told if I was planning pregnancy that I was to take a prescribed amount, I can't remember how much exactly it was but I can remember it was around 20 times larger amount than the average expecting mother. Do you recommend I ask for anything else after this test. It says at the bottom of the results ...

"vitamin b12;serum folate level; borderline. Need to repeat test. Borderline MCV and folate. Check RBC folate and if low treatment with supplements for life"

I guess it's a case of waiting for this next test result and see where they go from there. Do you think I've got anything to worry about?

I bet my problem is trivial compared so some of you x

[Gempep in reply to Gempep]

Also in terms of how long I've been feeling like this it has been as long as I remember, I have no social life because I'd rather be in my pjs relaxing as always been tired. If I'm not at work I'm in my pjs. The anxiety is what started months ago, June/July.

[clivealive Forum Support in reply to Gempep]

It is important that your Folate level is monitored as this is essential to process the B12 you are getting from your diet - especially meats, fish, seafood, eggs, poultry and dairy produce.

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.

I am not a medically trained person but have had P.A. for 46 years, am on three weekly B12 injections and have taken 1 – Folic Acid 400μg tablet every day for more years than I can remember.

I wish you well

[Gempep in reply to clivealive]

Thank you Clivealive,

I think it's just a case of seeing what the doctors say. It seems so complicated to understand it all, I have read so much yet struggling to make sense / translate it all. The main thing I've learned is that like you both say that things can be missed and tests for b12 aren't that reliable as they read both active and inactive b12 that our bodies can't use. I just don't want to trust my doctors too much as it seems a lot of you have been let down by being misdiagnosed

Thank you for your kind words.

I wish you all well too x

[Polaris]

Hi Gempep

According to latest BMJ research document, there is no completely reliable test, and with both your B12 and folate borderline plus neurological symptoms, you should be treated with B12 injections without delay. *

Large red blood cells with the neurological symptoms you mention are classic signs of B12 deficiency and, although medication for epilepsy may have depleted B12, IBS is very relevant and could be linked to Inability to absorb B12 and other nutrients, as you obviously have a good diet.

B12 deficiency is v. subtle and creeps up slowly over time so, the sooner it is treated with injections, the faster you will recover and avoid permanent neurological damage - see Dutch results and other information in the pinned posts on the R/h side of forum.

This is a link to the latest BMJ research document - summary only - GP should be able to access the full document:

bmj.com/content/349/bmj.g5226

*It also contains information regarding frequency of injections for neurological symptoms : 'every other day until no further improvement' (British National Formulary).

I hope this helps you get early treatment.

[Gempep in reply to Polaris]

Thank you so much Polaris,

It seems you all know you your stuff. I will take a read of that link in the morning. It's so complex.

Thanks all of you for all your help I really appreciate it.

I hope all of you are well and treatments are working for you all x

[Gempep]

Hi guys,

Not sure if you will get this notification yet worth a try..

So I had my red cell folate result back today. Once again as suspected it is low. Receptionist at the doctors just said I had a prescription at my pharmacy for folic acid 5mg. That was that. I've asked for the doctor to call me to discuss the results tomorrow.

I just want to be prepared for his call. Recap, my vit b12 was 313ng/l (180-900) and my folate 2.1ng/ml (3-17). Not sure on the red cell folate figures yet receptionist says low again and to take 5mg for life.

How does pa get diagnosed? Does this mean I am anaemic? Also I'm aware that the active b12 and inactive b12 is all captured with the serum b12 test, so do I need to ask for a intrinsic factor test? To determine active vs inactive?

They haven't asked me if I have any symptoms what so ever. I basically saw the doctor for my anxiety and mood swings and at the end of the appointment I asked him to check my b12 as I'm always tired. He almost laughed and said that he doesn't think I'm deficient but he will do it to put my mind at rest.

Now with me having almost all the symptoms of b12d (Only noticing the link once I started reading) Am I entitled to ask to be referred to either haematologist or neuro doc? Or am i over reacting? I'm 50 50 on whether I should be following this through to get answers or just do as I'm told and take the 5mg folic acid and forget about the b12. What do you recommend. Sorry it's so long. X