Low b12, gallstones and bilirubin

[foxrabbit]

Hi everyone, I’m just following up on my brother’s test results. He had a test done through medichecks in October which showed very low b12 levels and he also has pins and needles in his arms and hands from time to time. The medichecks results were as follows:

B12 120 (140-724)

Folate 3.92 (2.91-50)

I got him to go to his GP for further tests which he had this week and are as follows:

B12 273 (130-1100)

Folate 4.3 (2.7-15)

MCV 83 (83-101)

Bilirubin 39 (0-22) *above high reference limit

All other results of the full blood count and liver function tests were all in the middle of the references ranges so I haven’t included them.

Over the last year he has had a couple of nights where he has had severe stomach pains and he thought this could be due to gallstones. I have read a lot of links recently between low b12 and gallbladder pain as well. Enlarged red blood cells due to low b12 apparently get stuck in the spleen and gallbladder.

His high bilirubin levels add to the confusion as they could indicate break down of high levels of red blood cells but it could also be linked to gallstone formation!

So, here are my questions that I’m hoping you can all help to answer...

1. Why is his mean cell volume right at the bottom of the reference range when low b12 usually causes enlarged red blood cells?

2. Does anyone else have experience of gallbladder pain or gallstones related to low b12

3. Is his high bilirubin level linked to low b12 or to potential gallbladder problems?

4. What should he do next? His doctor doesn’t seem concerned by his latest b12 results or the high bilirubin level but I’m sure it’s all linked and I don’t want him to be ignored by his GP and go on to get worse

Thank you all so much for any thoughts you might have on this

[gg317]

great questions, hope someone answers

[Gambit62 Administrator]

MCV may be bottom of range but that doesn't mean it is abnormal. It is possible to have a mix of macrocytic and microcytic anaemia going on - which could be caused by iron deficiency going on at the same time as folate/B12 deficiency but this would generally be linked to a high RDW. Not sure if RDW was included in the full blood count - sometimes it isn't.

If the first test was done using a home kit there is an increased possibility that the sample wasn't quite right.

liver damage can lead to the liver dumpting B12 but this doesn't seem relevant if all the liver-function tests except bilirubin were normal.

[foxrabbit in reply to Gambit62]

Thanks for responding Gambit62. He had ferritin tested in his first tests done from home and it was in the middle of the reference range but the NHS didn’t test it. Hopefully that was accurate though and he doesn’t have any problems with iron. They didn’t do RDW on these tests.

What do you think he should do next? Do you think he might have a B12 issue or do the NHS tests being higher make this seem unlikely? Should i get him to take B12 supplements now that the NHS doctor isn’t bothered by his levels?

Thanks

[Gambit62 Administrator in reply to foxrabbit]

personally I'd be inclined to park B12 for the moment - and rule out the most likely explanation - which would seem to be gall stones.

[foxrabbit in reply to Gambit62]

Ok, will do. Thanks for your advice

[Hidden]

For about one year prior to having my Gallbladder removed I had serious pain in my upper right side as bad as childbirth the pain would last anything from 3 hours to 5 hours but not my stomach. I also had itching on my back right hand upper side a sign of troubled liver and gallbladder. I never had low B12 It could be something different. An ultrasound would soon show up any stones in the gallbladder.

[foxrabbit in reply to Hidden]

Hi bunnyjean, I’m not sure where his pain was exactly but he said each time it has lasted for a few hours before subsiding. He hasn’t mentioned itching though. I’ll get him to pursue the gallstone route and see how that goes. Thanks

[Hidden in reply to foxrabbit]

Your welcome

[Marz]

Gall bladder issues are often linked to low thyroid. Lowered metabolism makes for slower processes within the liver ....

[foxrabbit in reply to Marz]

Hi Marz, thanks for your reply. Luckily he’s had his thyroid properly tested and the results were all good. The reason he had the first set of tests done was because thyroid problems run in our family so I urged him to have his checked and all of his results were perfect other than b12 and folate, so it shouldn’t be the cause of his problems

[Foggyme Administrator]

Hi Foxfabbit

3. Is his high bilirubin level linked to low b12 or to potential gallbladder problems?

Raised bilirubin levels can be caused by blocked or scarred bile ducts (could be due to damage caused by passing a small stone or indeed by a bileduct being inflamed or blocked by a gallstone). Here's more information on bilirubin:

labtestsonline.org/understa...

Surprised your brother's GP hasn't referred him for an ultrasound (at least) to check for the presence of gallstones - or perhaps an inflamed gall bladder, both of which could be responsible for the pain.

Here's some information about Cholecystitis (inflammation of the gallbladder):

mayoclinic.org/diseases-con...

nhs.uk/conditions/acute-cho...

And here's something about a potential connection between gallbladder issues and B12 deficiency:

livestrong.com/article/4798...

So, as per gambit62, think I'd suggest ruling out gallbladder issues first and then come back if you need more advice about potential B12 issues.

Good luck 👍

[Gudge66]

I get loads of pressure type, sensations from my Gallbladder. I have had several ultrasound scans and all come back negative.

[jillc39]

all I can add is that while I am sorting out severe b12 deficiency I have suddenly had to have my gall bladder removed and I am fascinated to know more about the possible link between the two.

[MensaKaren]

You desperately need more b12!

The B12 reference range is not equivalent to a healthy level of b12! You need at least 550 but actually a different test is a better determination a B12 deficiency (tissue saturation) -MMA test- urine or blood... and some people with deficiency have genetic mutations that require can consideration. (MTHFR)

I had b12 deficiency symptoms at 182 to 297 and 743 b12 blood test! The good news is that High dose methyl B 12 orally healed my GI symptoms in 2 months or less -I was misdiagnosed with needing my gallbladder out b/c I had some stones -kept it anyway- truly had gastroparesis -its symptoms mimic gallstone/gb problems.