Low iron: Evening everyone! I was just... - Pernicious Anaemi...

Pernicious Anaemia Society

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Low iron


Evening everyone! I was just wondering if I can ask if anyone knows. I got told had folate deficiency anaemia and given 2 months folic acid. Then got told folate only 3 below normal but low iron. Not given iron. Should I take some Iron? I started a bit of b12 as had numerous health issues this winter 3 x bouts flu which has caused asthma now on blue Brown inhalers. Also have vit d deficiency which had full course tabs. I'm trying everything to help myself as don't want to get another bout flu or suffer any more uncontrolled asthma/chest pain/shortness of breath. Thanks in advance x

3 Replies
clivealiveForum Support

Hi Prestart55 I would go back to your doctor (or whoever is telling you about your low levels) and ask to be given an appropriate prescription for whatever supplement you need.

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

I am not a medically trained person but I've had P.A. (a form of B12 deficiency) for more than 45 years.

I wish you well



Some info below may be UK specific. I am not medically trained.

Do you know what your B12 level is?

I always get copies of all my blood test results. I learnt to do this after being told everything was "normal" and then finding abnormal and borderline results on the copies.

Access to Medical Records (England)



Are you symptomatic for B12 deficiency?

It's possible to be symptomatic with B12 levels that are within the normal range.

"or suffer any more uncontrolled asthma/chest pain/shortness of breath"

Shortness of breath and vascular problems can be symptoms of B12 deficiency. I hope your doctor has investigated what is causing your chest pain.

B12 Deficiency Symptoms



b12d.org/admin/healthcheck/... (may need to be B12d.org member)

Link about What to Do Next if B12 deficiency suspected.


Folate Deficiency

I have read that it's important to treat any co-existing B12 deficiency if receiving folate treatment. See Management section in link below.


UK B12 guideline stress need to treat people who are symptomatic for B12 deficiency even if B12 level is within normal range.

If you're in UK, I'd suggest reading all following documents.

BSH Cobalamin and Folate Guidelines

Cobalamin is the scientific name for B12.


Flowchart from BSH Cobalamin and Folate Guidelines


BMJ B12 article






More B12 info in pinned posts on the forum. There is a useful summary of b12 documents in third pinned post.

Risk Factors for PA and B12 Deficiency




What does GP think is causing your low folate and low iron?

Has diet been excluded as a possibility?

Sometimes having nutritional deficiencies can be a sign of absorption problems in gut.

In relation to B12, I look at B12, folate, ferritin and full blood count. There are other tests that can help to diagnose B12 deficiency besides serum b12 eg Active B12, MMA, Homocysteine.

If you are symptomatic for B12 deficiency, has your doctor ordered an Intrinsic Factor Antibody (IFA) test? This can help to diagnose PA (Pernicious Anaemia) but IFA test is not always reliable and it is still possible to have PA even if IFA result is negative or normal range.

"I started a bit of b12 "

Taking B12 supplements prior to tests for B12 deficiency can make it difficult to get a diagnosis.

B12 Blood tests




Full Blood Count and Blood Film



PAS (Pernicious Anaemia Society)

Based in Wales, UK. PAS offers support and info about PA.


PAS tel no +44 (0)1656 769717 answerphone

PAS support groups in UK


Coeliac Disease

In UK, NICE guidelines on Coeliac Disease suggests testing anyone with unexplained B12 deficiency, folate deficiency or iron deficiency for Coeliac disease.

Have you had tests for Coeliac Disease?

In UK, two first line tests are recommended.

1) tTG IgA

2) Total IgA

My experience is that Total IgA test is not always done but I think it's an important test as people with IgA deficiency will need different tests for Coelaic disease.

NICE guidelines Coeliac Disease (2015 version)


Coeliac UK website


UK B12 blogs

Martyn Hooper's blog about PA


B12 Deficiency Info blog


B12 books I found useful

"What You Need to Know About Pernicious Anaemia and 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 with lots of case studies.

Misdiagnosis of B12 deficiency


Misconceptions about B12 deficiency (English language article from Dutch B12 website)


I hope you get any treatment that you need and start to feel more comfortable soon.

Very good comprehensive reply from sleepybunny.

All you need to know I think.

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