Sorry if this has been asked before or the answer is in an obvious place: Can you have fatigue caused by lowish b12 without being anaemic? My total b12 came in at 341, I know this could be lower but I have been experiencing heavy fatigue and tiredness, depression, pins and needles, disorientation, low libido etc. I had also been taking 2mg hydroxo sublinguals in the build up to the test, bit silly, but I think that might have raised the result. FBC was good other than slightly low (in normal) white blood cells.
Folate is 19.4nmol/l low in the normal range.
Ferritin 117ug/l also low in the normal, do these need addressing?
Thyroid function is pretty bang on, no antibodies.
GP won't do anything obviously, but I can consider going to a private clinic for injections if needs be.
B12 is used by a number of systems at the cell level - which means anaemia (effect of lack of B12 on the production of red blood cells in bone marrow) is not the only way that B12 can cause fatigue and tiredness, eg it also plays a role in the process that allows your cells to release energy by converting ATP to ADP.
As a doctor, I can not find a satisfactory answer for the weakness, muscle fatigue and shortness of breath I feel, even replacing hydrocobalamin every other day for the last 9 months ...
I have no anaemia, my levels of folate, potassium, copper, ferritin, etc. are all normal and the symptoms persist ... As Gambit said, once you become deficient in B12 for a long time, there are probably more metabolic problems involved in this complex process.
I self inject weekly between my 12 week NHS jabs. The tiredness is still there, but not as bad. It got better when a vitamin D deficiency was found, but still didn't go completely. I'm having investigations to see if anything else is going on that would cause the ongoing tiredness at the moment.
Might be worth mentioning that although I still have problems, presumably due to b12, I found massive relief in my tiredness after I started taking CBD oil. It didn't give me more energy directly but definitely changed my quality of sleep.
"been taking 2mg hydroxo sublinguals in the build up to the test....think that might have raised the result"
It may have raised results.
Do you have any other B12 results from last few years to compare recent result to? If your B12 results have been declining over a period of time, that could be significant.
How long were you taking sub-linguals for? This link suggests that supplementing with b12 before diagnostic tests for b12 deficiency can make it very difficult to get a diagnosis.
1) Copy of Martyn Hooper's book "What You Need to Know About Pernicious Anaemia and B12 Deficiency".
2) Copy of BSH Cobalamin and Folate Guidelines
3) Copy of PAS Symptoms Checklist with all my symptoms ticked plus I added any not on list
Some GPs find it difficult to cope with assertive patients so it's possible doctor/patient relationship may be affected. I prefer to put info I want GP to read in a brief, polite letter. My understanding is that in UK, letters to GPs are filed with a patient's medical notes. See letter writing link at top of this post.
Do you have anyone supportive who can go with you?
If you suspect PA (Pernicious Anaemia) is a possibility, may be worth joining and talking to PAS before next appt. There are PAS support groups in UK.
Pins and needles is normally considered to be a neuro symptom. Do you have other neuro symptoms?
NICE CKS link and BSH Cobalamin and Folate Guidelines link in my post above suggests that GPs should seek advice from a haematologist for people who are symptomatic for B12 deficiency with neuro symptoms.
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pernicious anaemia without actual anaemia
Symptoms but “normal results” 
New to Pernicious Anaemia
Cause of fatigue
