Do I have enough evidence of PA?

[Ilala]

I got my results back. I tested negative for ifab but positive for parietal cells. I have the symptoms of PA.

I also tested positive for hashimotos.

My B12d was lower in December 2016. That was 195

I am attaching my most recent results

Any thought appreciated.

[Gambit62 Administrator]

Unfortunately GPCA isn't a conclusive test - it can give false antibodies.

There does seem to be something odd going on with the red folate test - though not sure what - it's outside the range but the notes indicate that there isn't a deficiency. Can't find anything specific in the guidelines that would explain this. red cell folate is a measure of long term folate status (4 months).

The symptoms of folate deficiency have a strong overlap with B12 deficiency, as do the symptoms of hashimotos.

Suggest you double check the units and ranges on the previous B12 test - there are two ways of measuring it so the two results could be very similar.

The ratio of active B12 to serum B12 is usually about 20%. Adjusting for the units yours looks as if it is about 16% which could indicate a problem metabolising B12 but I'm not an expert.

There is nothing in the full blood count to indicate any form of macrocytosis (larger rounder red blood cells) but this isn't present in about 25% who are B12 deficient. when they first present.

Sorry, but the position is still far from clear.

[Martin_12]

In the introduction to this article:

ncbi.nlm.nih.gov/pubmed/170...

the authors say that "Transcobalamin saturated with vitamin B12 (holo-TC) constitutes 6%–20% of endogenous circulating vitamin B12, whereas

unsaturated TC constitutes 90% of TC". If they are right then the ratio of active B12 to total serum B12 can vary quite widely.

This study:

ncbi.nlm.nih.gov/pubmed/208...

suggests that neither total serum B12 nor active B12 are particularly good at detecting B12 deficiency defined as increased methylmalonic acid.

If you have symptoms of B12 deficiency it would be worth getting methylmalonic acid and homocysteine tests. As these are also not 100% reliable at detecting B12 deficiency, a trial of B12 supplementation may be worthwhile (preferably injections but high dose oral may work).

[Ilala in reply to Martin_12]

Thank you so much.

I managed to persuade my GP to start the loading injections but he refused to read the guidelines and letter from the pas. He hasn’t referred to a haematologist or offered any more blood tests than a test for celiac (his idea). He also told me to not take any folate supplement as it would damage my spinal cord! Oh dear !