Results advice please

[Zara1213]

Nothing done about them thank you

Ferritin 4 (15 - 150)

Folate 1.3 (2.5 - 19.5)

Vitamin B12 135 (180 - 900)

Vitamin D 34.4

[Lisahelen]

Seeing results like that, your dr is being nothing less than negligent in my opinion. At the very least all your readings should be above the lowest reference range -why else would there be one!

If you are up to it you should go back and challenge your dr.

[Sleepybunny]

Hi Zara1213,

Are you in UK? I'm asking because patterns of B12 treatment vary from country to country. If you're not in UK, some info below may not apply.

I am not medically trained, just someone who has spent years trying to find out what is wrong with me.

I'm very surprised that you have not been offered any treatment because these results show low folate, low b12, low ferritin.

Not so sure about Vitamin D as I can't see a reference range. Were the units nmol/L? If yes then a result of 34.4 nmol/L would usually be considered as "Insufficient" in UK with treatment recommended if person is showing Vit D deficiency symptoms.

NICE guidelines Vitamin D

cks.nice.org.uk/vitamin-d-d...

Risk factors for B12 deficiency and PA (Pernicious Anaemia)

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

Do you have a good diet?

Are you vegan or vegetarian? I'm asking because these diets can be a risk factor for developing B12 deficiency.

Do you eat B12 rich food eg meat, fish, shellfish, dairy and eggs?

If yes, then it becomes less likely that diet is cause of low B12 and more likely that there is an absorption problem.

B12 Deficiency Symptoms

In UK, emphasis is on treatment for people who are symptomatic for B12 deficiency even if B12 level is within normal range.

Are you symptomatic for B12 deficiency? See lists below.

pernicious-anaemia-society.... see Checklist PDF on right of page.

b12deficiency.info/signs-an...

Do you have any neuro symptoms eg tingling, pins and needles, tinnitus, memory problems, balance issues?

In UK, people who are symptomatic for B12 deficiency with neuro symptoms are supposed to have more intensive B12 treatment.

UK B12 articles/documents

If you're in UK, I suggest reading all of these plus the summary of B12 documents in third pinned post on this forum.

BMJ B12 article

bmj.com/content/349/bmj.g5226

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

Flowchart outlines when PA and Antibody Negative PA can be diagnosed in UK. It makes it clear that in UK, people who are symptomatic for B12 deficiency should have an Intrinsic Factor Antibody test and start initial b12 treatment.

IFA test can help to diagnose PA but it's not always reliable and it is still possible to have PA even if IFA result is negative or normal range.

Have you had an Intrinsic Factor Antibody test?

BNF British National Formulary Chapter 9 Section 1.2

bnf.nice.org.uk/drug/hydrox...

cks.nice.org.uk/anaemia-b12...

Details of UK recommended B12 treatment. UK GPs will probably have acopy on desk or bookshelf. Treatment info is also in BSH Cobalamin and Folate Guidelines.

B12 books I found useful

"What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Martyn Hooper is the chair of PAS (Pernicious Anaemia Society). Book is up to date with UK B12 guidelines.

"Living with Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Has several case studies.

"Could it Be B12; An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)

Very comprehensive book about B12 deficiency with lots of case studies.

PAS (Pernicious Anaemia Society)

pernicious-anaemia-society....

PAS tel no [phone] answerphone

If you think PA is a possibility, it may be worth joining and talking to PAS. They are based in UK but have members from around the world.

PAS members can access details of PAS support groups; there are several in UK.

pernicious-anaemia-society....

Link about what to do next if B12 deficiency is suspected.

b12deficiency.info/what-to-...

Links about blood tests

b12deficiency.info/b12-test...

patient.info/doctor/macrocy...

patient.info/doctor/folate-...

Full Blood Count (FBC), known as Complete Blood Count in USA.

Have you had a full blood count? Have you got the results?

labtestsonline.org.uk/under...

There can be useful clues on FBC as to whether B12 deficiency, folate deficiency, iron deficiency are possibilities.

Low iron can lead to smaller red blood cells (microcytosis). Low B12 and low folate can lead to enlarged red blood cells (macrocytosis). A person with both low iron and low B12/low folate may appear to have a normal range MCV on the Full Blood Count (FBC) because the effects of low B12/folate on red blood cells can be masked by effects of low iron.

Access to medical records (England)

nhs.uk/NHSEngland/thenhs/re...

england.nhs.uk/contact-us/p...

nhs.uk/chq/Pages/2635.aspx?...

Unhappy with treatment (UK info)

Link about writing letters to GP about B12 deficiency.

b12deficiency.info/b12-writ...

CAB NHS complaints

citizensadvice.org.uk/health/

HDA patient care trust

UK charity that offers free second opinions on medical diagnoses and medical treatment.

UK B12 blogs

There may be stories on these blogs that are relevant to you.

Martyn Hooper's blog about PA and B12 issues

martynhooper.com/

B12 Deficiency Info blog

b12deficiency.info/blog/

I am not medically trained.

[Gambit62 Administrator]

were these private results?

suggest that you discuss with your GP - they may want to repeat to check that the results are accurate - but everything there implies you have multiple deficiencies - probably due to auto-immune gastritis which is very common in conjunction with autoimmune hypothyroidism.

[KimberinUS]

I cannot believe your doctor has done nothing about these results. I imagine if they are private you have been to him complaining about excessive fatigue and he said you were fine per whatever test he did allow you to have.

Be prepared to fight for the correct treatment. I advise you take someone with you to all appointments, as these levels indicate you feel like death is around the corner, which doesnt allow for rational, logical, analytical thinking/conversation during an appointment with the gp.

Best of luck to you during your time of need.

Please make sure to have your tsh, t4 and t3 checked regularly, as in every 6 weeks, because b12 and iron may improve the functioning/production of those hormones and you may then become overmedicated.