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Pernicious Anaemia Society
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Balance of b12, folate and iron??

Hi all!

Starting week 4 every other day b12 injections with weekends off.

My results today.....B12 >1100 (normal >133) I was originally at 114 which was considered borderline and <107 being deficient.

RBC folate ....1355 (normal>829...deficient anything below 340 nmol)

Ferritin....66 (range 15-50 depletion of iron stores, probable iron deficiency, 51-100 reduced iron stores, possible iron deficiency, 101-300 iron deficiency unlikely)

Normally my folate fluctuates between that and 2300 without supplements throughout the week) and ferritin was 66 which has dropped from 115 a month ago.So I finally got a level for all 3. I'm trying to balance them out as it doesn't seem too important to my doc so I'm taking it upon myself. He did say I am ok to take 400 of folate daily along with 28 mg of iron (ferrous bisglycinate). I'm afraid of taking more than that as I've never had an iron issue. I suppose it's better than nothing. I tried the 35 mg of ferrous glauconate but it bothers my stomach.

Also, my platelets have dropped a bit as well. Is this normal? Any advice would be appreciated as when I asked my doc how my blood work looked, his response....."pristine". 😳

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I agree with the doc.

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You don't think my iron is a little low?


Yes. Which is why I agree with his suggestion of iron bisglycinate.

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Oh gotcha! I actually suggested to him that I take it but not sure it's enough. He didn't think I needed it. Yet, there I was with my eyes closing in the office. I also don't understand why my platelets have dropped. Is that normal? And if you can explain to me why iron falls as well. Thank you for your reply btw!


Sorry can't help with the platelets.

You may have a problem absorbing iron caused by the same thing that is giving you a B12 deficiency.

If you have gastric atrophy then your stomach won't be producing enough Intrinsic Factor (needed to absorb B12). Nor will it be producing much acid.

For iron to be absorbed from the gut it needs to be in solution. And iron dissolves much better in acidic conditions. So your low-acid stomach isn't very good at dissolving iron, so it doesn't absorb it too well.

One way to help is to make the iron into something called a chelate. That's where the iron is bonded to one, or more, organic molecules, which help it to dissolve. If you take iron sulfate tablets you can boost absorption by taking them with citric acid and/or ascorbic acid (vitamin C). These are both good chelating agents.

Or you can take the iron already chelated, like iron fumarate or iron bisglycinate (my particular favourite). I take one 25 mg iron bisglycinate capsule every other day. And it keeps my levels OK.


Thanks you! I am taking a 25 mg iron bisglycinate with contains vitamin c, folate and a small amount of b12 with orange juice along with my injections. Hoping this starts to increase soon.

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Hi Plucky11966.

B12 deficiency and / folate deficiency can cause a low platelet count (called Thrombocytopenia).

According to Healthline.com, some causes of low platelet production include:

aplastic anaemia

a vitamin B-12 deficiency

a folate deficiency

an iron deficiency

viral infections, including HIV, Epstein-Barr virus, and chickenpox

exposure to chemotherapy, radiation, or toxic chemicals

consuming too much alcohol




Here's a link to the site, where you can find more about low platelets:


More information here too:


One of the functions of platelets is to aid blood clotting so, if platelets are low, bruising tends to occur (one reason why those with B12 deficiency can suffer from easy bruising).

Some drugs can effect (in this case, reduce) platelet production (e.g. antibiotics), as can viral or bacterial infections, autoimmune conditions (other than PA), chronic bleeding - heavy menstruation).

Ironically, platelet count can also be increased as a result of the body’s reaction to low platelets (it produces more to compensate when low).

So, all-in-all, it’s a bit of a fluid (or should I say blood) 'balancing act'.

Your say that your platelet count has 'dropped a bit' and that's not inconsistent with B12 deficiency and the body's platelet 'management' system.

Think your GP would not have used the word 'pristine' if it was anything to worry about.

Hope this helps.


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Thanks for the info! It's hard not to worry when you feel like the only reason you are being treated is because you've been the one driving the bus....sigh. Just want to start feeling better.

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