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Pernicious Anaemia Society
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Update to looking for advice

Saw my GP Monday and to my surprise he really listened and was open to B12 injections, even if b12 levels are "ok". I've had blood taken for FBC, full iron (says ferritin doesn't tell you anything), folate, b12 and IFA. He says we need to ensure folate levels are high enough before starting b12 and that I might need to supplement with that first. Us that correct? He did say that he didn't want to start injections unless absolutely necessary as they would be for life, although it wasn't a problem. He said that after one injection I may be able to keep the levels up with tablets. It definitely helped that my husband was there and could confirm my balance problems and also that I have a chest infection and dizziness at the moment. So all in all quite positive, although I wonder about the folate.

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Wonderful to hear about such a well educated GP.

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So many bad GPs so thought it good to give credit where credit due

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Just a thought. There may be others in the surgery not as good as your GP. I wonder if your GP has let colleagues know of his expertise in this area, it might help many others in your surgery, if they are struggling.

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I'll follow that up at my next appointment, he certainly seemed very receptive to ideas.

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Hi janefraser according to NHS Choices

"Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency".

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

You don't say what your B12 level is but if you are deficient I think it is reckoned better to start supplementing with folic acid a day or so after B12 treatment commences.

I am not a medically trained person but I'va had P.A. *a form of B12 deficiency) for 46 years.

I wish you well

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Interesting, GP definitely said folic acid first (if necessary) before B12.

B12 has 167 in June, then I took a multivitamin and it increased to 224 two months later, before falling slightly to 207 at the start of November. So unlikely to be pa. I'm not vegetarian and my diet is good.

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Sorry I was a bit confused - was it on Monday your doctor said ".... we need to ensure folate levels are high enough before starting b12 and that I might need to supplement with that first"?

Yet you say above you were B12 deficient in June and had already been taking B12 supplements and raised your serum level so my comment about "it is reckoned better to start supplementing with folic acid a day or so after B12 treatment commences" was irrelevant.

Yes you do need to have a healthy level of Folate as this and the B12 you are going to have injected help your iron to make red blood cells and to function properly in your body.

Hopefully your GP will investigate further as to the cause of your deficiencies.

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BCSH guidelines are to start treatment for B12 just before you start treating a folate deficiency because there is a very very small risk of preciptating SADC. But time delay is about 24-48 hours - and you do need adequate folate levels to be able to use B12

Some people do manage to maintain levels with very high dose oral tablets(>1000mcg but that doesn't really take away the need for loading shots - rather than just one shot.

Doesn't work for everyone though.

Your GP can access the BCSH guidelines on diagnosis and treatment of cobalamin and folate deficiencies through the BNF but they are also available here

onlinelibrary.wiley.com/doi...

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