Pernicious Anaemia Society
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Blue Veins / low ferrtin/ low b12

Hi! I'm new here. I'd love some help. I've been seeing a functional medicine doctor the last 9 months. I've been diagnosed with low Thyroid function, low ferrtin (21), and low B12 (serum level is high now but methylmalonic acid is elevated) . I started on iron supplements in August. I've been taking b12 sublingual for 6 months. I'm worried bc I developed sudden blue veins all over both breast in August and one going up my chest. It hasn't gone away. My doctor seems stumped. She keeps telling me it's my lymph system that's backed up. Seems to me to make sense it's iron/b12 related? Can anyone help me? I'm so worried I'll be see through forever and I'm only on my 30s. 😓

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Go and see a real doctor.

Raised MMA can have causes other than low B12 and you need to have those checked as some of them can be very serious.

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I started off with conventional dr after conventional dr for 5 years. No one could find anything wrong with me. Once I went to see a functional medicine Dr they found the low Thyroid, low ferrtin (convential dr checked iron which is fine but ferrtin is really low), and elevated MMA (conventional dr checked serum b12 but never MMA). My homocysteine level is really low (3). I'm trying to get referrel to hemotologist. Is that what kind of Dr you think would be best for this problem?

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You have rather see MMA and normal homocysteine. That strongly indicates that the MMA is not being raised due to a B12 deficiency.

I really, really hope that you have had liver and kidney function tests so nice the MMA result as it can be raised by problems with either of those. And liver or kidney problems can be serious.

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My last labs taken in August are as follows.

b12 blood serum level is marked high at >2000 pg/ml (200-1100pg/ml) range

Methylmalonic acid, serum is 274 nmol/L (0-378) range

Homocysteine: 3

I've asked for liver function test, but I'll call and ask for kidney as well. When I asked for liver test last week the Dr said my last liver test was normal. Anything else I should check?

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Yes.

You should check why you had to ask for liver and kidney function tests, rather than the doctor advising you to have them.

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I haven't been able to go over the results from the doctor but my liver results are back. My ALT (sgpt) reads HIGH at 49 IU/L (0-32). All other values on the test are normal range. What do you think this means?

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Kymbo5566 - are you based in the UK or somewhere else - just useful to know because of the differences in medical regimes.

Are you seeing an MD who is practising a holistic approach to medicine or are you seeing someone who is practising a branch of functional medicine - which, at least in the UK, tends to mean a qualification in nutrition.

Its really difficult to know where to turn when conventional medicine fails you ... and the tendency to focus in conventional medicine on treating symptoms rather than treating the person can make functional medicine which takes the opposite approach rather attractive. I thought about functional medicine in relation to a thyroid condition but here it seems to all be nutritionalists and some of their ideas and focus don't fill me with a great deal of confidence so haven't gone down that route.

As fbirder says raised MMA is something that needs to be looked at. When you say your B12 levels are now high that isn't necessarily good news - particularly if high means above the normal range. Although B12 isn't toxic high levels in the blood can cause a reaction in some people that then stops the B12 moving from your blood into your cells where it is needed. High MMA could be a result of this reaction. However, high MMA isn't necessarily an indicator of B12 deficiency as it is also raised by conditions that affect liver and kidney function so those need to be checked.

I've not come across the symptom you mention in relation to B12 before so I'd be wary of assuming that it really is related to B12.

You don't say if you are still symptomatic of B12 deficiency and if so what your symptoms are.

I presume that the possibility of varicose veins has been ruled out - what I think of when I think of veins being visible - although these generally appear on the legs this isn't always the case. Don't think this is a condition that either iron or B12 deficiency are associated with.

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Hi, thanks for taking the time to help me. I'm in the US and I'm seeing a very good MD known as the best functional medicine practice in our country. Dr Mark Hymans clinic.

I have felt better since starting T3 for my thyroid. I have plenty of energy now. My current symptoms that remain are brain fog, hair loss the last 7 months, visable veins appearing suddenly on chest, occasional muscle weakness.

b12 blood serum level is marked high at >2000 pg/ml (200-1100pg/ml) range

Methylmalonic acid, serum is 274 nmol/L (0-378) range

Both these test were done in August. My Dr just reordered MMA and I will get results back soon. Maybe even today.

I just asked for my liver function to be retested. I should also test kidney?

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not sure why you are saying MMA is high if the results above are quoted correctly as it is in the middle of the range - so not an issue.

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My Dr told me they were elevated so I went back and pulled this test. She may have said they were elevated based on my ION test. She wanted to re test them bc she said my last results were elevated. I'll call to see if I can get new results.

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hope you get to the bottom of it

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Are you being optimally treated for your thyroid ? Do you have Hashimotos ? There is an excellent Thyroid Forum here on HU - Thyroid UK. Maybe some good advice for you there :-)

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I don't have any antibodies for thyroid so I don't have hashimotos but my t3 is less than optimal at 2.3. I've been taking just t3 10mcg the past 6 weeks. I'm still having hair shedding but have more energy.

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If you are not taking T4 then you need an increase in T3 once your B12 - Folate - Ferritin - VitD are all optimal. What was your TSH and FT4 result ? Low iron and VitD - also zinc can contribute to hairloss ...

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Very few doctors, allopathic or functional, seem to have read latest research on B12 deficiency Kymbo. This is a link to the latest BMJ research document summary :

bmj.com/content/349/bmj.g5226

It states that there is NO reliable test and that symptoms are paramount.

The document also contains information regarding frequency of injections for the neurological symptoms (brain fog, fatigue, muscle weaknes, etc): every other day until no further improvement (British National Formulary).

It is estimated that 12 per cent of people with hypothyroidism (most being autoimmune) also have PA, as gastric atrophy from thyroid disease may eventually lead to low stomach acid and lack of absorption of B12.

This is what the BCSH guidelines have to say about autoimmune disease in general:

"Pernicious anaemia is one of a number of autoimmune diseases, including Hashimoto's disease, type 1 diabetes, vitiligo and hypoadrenalism, which may coexist together."

ncbi.nlm.nih.gov/pmc/articl...

Here are other helpful links - including a film showing how one of Dr Chandy's patient's hair grew back after B12 injections:

b12deficiency.info/what-to-...

b12deficiency.info/films/

Is it possible blue veins may caused by extra blood supply or hormonal? as this is also one of the early signs of pregnancy - I hasten to add I'm not a medic

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Thanks so much for your reply. I should have mentioned I have super low stomach acid. I can take up to 8 HCL pepsin pills with a meal and still not get heartburn.

I know I'm not pregnant but wonder if the iron is increasing my blood flow. I took a iron pill last night with red meat and a hour later my blue veins were worse than ever. I could even see them on my stomach. So scary.

Ironically the blue veins appeared in August. The same month I started iron pills. Blood flow?

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You probably already know that low stomach acid means that it will be hard to absorb B12, as well as other essential nutrients, so B12 Injections is the usual treatment as supplements will not suffice.

Have you been tested for H/Pylori? This can also cause gastritis, leading to gastric atrophy and therefore reduction in stomach acid....

Just a thought - it's important to be careful when taking iron or certain B vitamins supplements regularly as you can easily overdose.

Personally, having Hashi's and an absorption problem, I SI with Hydroxocobalamin every other day but only take iron (Floradix) and B complex every few days - daily Vit, C will also help absorb iron from food.

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Kymbo, ask for transcobalamin or B12 binding capacity test. This will tell how much B12 gets into your cells. It’s done in the US. That is great your homocysteine is low, you don’t want high. Do you mean abnormally low, or just low in normal range?

Which test results had your doctor diagnosing low B12? I have high serum B12 like you do, MMA normal, homocysteine normal, folate normal. I supplement methylb12 and methylfolate. I asked my doctor for the above test and intrinsic factor test. Intrinsic was normal, but wouldn’t you know it. I am deficient in B12 binding capacity, so the B12 is not getting into my cells correctly. It’s just floating around in my blood at high levels, not getting were I was hoping it would. Are there any abnormalities on this our CBC’s now, or consistently in the past?

What are the rest of your iron panel values? I also have low transferrin (cellular or storage iron) 23, but something unusual is wrong with my iron absorption abilities. Three weeks after started eating iron filled foods, taking C, and supplementing some iron, my ferritin increased 15 points. I’ve read it normally takes months to increase. My iron level itself stayed exactly the same, but all my other iron values decreeased aftering ingesting iron. I’m seeing a hemo next week. Have you had an iron panel since August? How much did your ferritin increase?

I’m not sure about your veins. Do you happen to be lean and very fit? Do you have any pain or other symptoms in those areas or anywhere? Have you had a recent CBC and comprehensive blood panel? Those are baseline tests that tell you RBC, WBC, RDW, hemoglobin, hematocrit, liver panel, blood sugar, sodium, etc and more, and might point you in a direction to investigate further.

On your thyroid, bothantibodies were tested? How long ago? That can change from negative to positive over time, if given the right circumstances. That’s your free T3 at 2.3? What’s your free t4 level and how much levo do you take? Your hypo symptoms are not under control, as you experience, if ft3 and ft4 are not optimal, and you are under medicated.

When was your last mammogram?

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Lastly, your thyroid needs good solid iron levels to function properly. Low ferritin in itself can be the cause of hair loss (some doctors recommend ferritin over 100 for hair regrowth) fatigue, brain fog. Couple with that low functioning thyroid (some doctors recommend ferritin being over 75 for optimal thyroid function) which can also cause hair loss, fatigue, brain fog, and it’s a double whammy.

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Thank for taking the time to help me. I hope I've answered all the questions below...

1. Do you mean abnormally low, or just low in normal range? My last homocysteine is 4.1 (3.0-14.0nmol/ml)

2. Which test results had your doctor diagnosing low B12? I'm honestly not sure I've taken so many test in the last 9 months but believe higher MMA levels on Genova ION test and blood MMA serum.

3. What are the rest of your iron panel values? My last iron values are..

Iron, total 74 (40-190mcg/dl)

Iron binding capacity 386 (250-450mcg/dl)

Saturation 19 (11-50)

4. Have you had an iron panel since August? How much did your ferritin increase

New Ferritin as of yesterday is 35!! (Started at 15 in August)

5. Do you happen to be lean and very fit? Yes, I'm lean but not muscular really. I haven't had the vein problem prior to August. Which ironically was the same month I started iron pills.

6. you have any pain or other symptoms in those areas or anywhere? No pain, except occasional muscle weakness like when I'm drying my hair.

7. Have you had a recent CBC and comprehensive blood panel? Yes all is normal I believe but I'll double check. I know I just did a liver panel again yesterday bc I requested.

8. On your thyroid, bothantibodies were tested? Yes twice in the last year and both negative.

9. That’s your free T3 at 2.3? Yes

10. What’s your free t4 level and how much levo do you take? Free t4 is 1.4 and u take 10mcg of t3 only.

Side note: my tsh is .92

11. When was your last mammogram? I got checked by gyn last month but they won't do mammogram until I'm over 40.

That's really interesting on the B12 binding capacity, that sounds like me bc my last b12 serum test was really high >2000.

I'm going to the doctor today. I'll ask for intrinsic factor test and transcobalamin or B12 binding capacity test. Anything else jump out at you? Thank so much for your help.

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Hi Kymbo!

1. Your homocysteine is not low, it's normal.

2. Do you have the MMA levels that were high? Current level is normal.

3. Iron looks normal.

4. Ferritin up to 35! That's great!

5. Did you start any new fitness program or alterations in your workouts?

6. Weakness could be low iron, B12, or other problems.

7. If you can look at previous CBC's and Comprehensive Metabolic Panels, see if there are any previous trends that stand out (like very low in range RDW) or if the latest one's show any notable changes.

8. That's great!

9. What is the lab range for your FT3?

10. What is the range of your FT4? (always best to post reference ranges because there are so many variations across all labs, otherwise cannot tell if a value is high, low, deficient, or overload).

11. Do you do monthly breast exams? Have you done exams since you've noticed the veins? Any lumps?

12. What was your baseline value when you were instructed to take supplements? You are supplementing B12 for 6 months. How much are you taking? I also supplement and my serum level increased over the last 2 yrs to past the lab range, >1500. That didn't seem right to me, plus I have symptoms and suspected something was wrong with my absorption, so requested those tests.

13. Unfortunately, unless you have been sustaining from all B12 in multivitamins and straight B12 supplements for at least 72 hours, you will not be able to take the test B12 binding capacity test. ARUP, Quest, Labcorp, Mayo and few other labs offer this test.

14. Other tests: maybe test full panel of all female sex hormones?

You're welcome!

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5. Did you start any new fitness program or alterations in your workouts? No

9. What is the lab range for your FT3? (2.3-4.2)

10. What is the range of your FT4? (always best to post reference ranges because there are so many variations across all labs, otherwise cannot tell if a value is high, low, deficient, or overload). (.8-1.8ng/dl)

11. Do you do monthly breast exams? Have you done exams since you've noticed the veins? Any lumps? Yes just went last month and was fine

12. What was your baseline value when you were instructed to take supplements? I'm not sure bc I wasn't aware of b12 deficiency when I started this health journey. I just started b12 as dr asked

You are supplementing B12 for 6 months. How much are you taking? I take vegansafe b-12 sublingual it's 2,500mcg 80% as methylcobalamin and 20% adenosylcobalamin. I also take a b complex plus from pure Encapsulations it has 400mcg as methylcobalamin.

Should I keep taking this much? Oh and I've never had a b12 shot

Sent from my iPhone

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I wrote out a long response yesterday, thought I'd hit send, and then just closed that window. I'll have to re-write it later. How did it go at the doctors?

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