VITAMIN B12 DEFICIENCY

[Kerry-78]

Hello

I am 39 and have been told for the past 20 plus years that I'm anemic which I on and off take ferrous fumarate for. I also have Rheumatoid Arthritis, I was due to have surgery 4 weeks ago but this was cancelled because my HB was to low, but has been booked again for 9th May ( 2 weeks today ). At my pre assessment last week more blood was taken and I was told Friday my HB was 91 which again is too low for surgery and they wanted me to ho back for some blood chemistry tests. The hospital have just phoned again to say that it is my vitamin B12 that is low, I asked how low and apparently it's 30 under the lowest of normal range ? Anyway shes made an appointment for me to have a B12 injections at my GP surgery today but also told me until she speaks to the anestetist tomorrow she wont know if surgery will go ahead on the 9th as she not sure how long it takes to go back up. So my question is does anybody know how long it can take to start going back up and how often can I have injections ? I did Google it and read you can have injections every other day for 2 weeks, is this correct ?

Any help much appreciated x

[clivealive Forum Support]

Hi Kerry-78 do you have any neurological symptoms?

Symptoms of B12 deficiency tend to develop slowly and may not be recognised immediately. As the condition worsens, common symptoms include:

Weakness and fatigue

Light-headedness and dizziness

Palpitations and rapid heartbeat

Shortness of breath

A sore tongue that has a red, beefy appearance

Nausea or poor appetite

Weight loss

Diarrhoea

Yellowish tinge to the skin and eyes

If low levels of B12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms:

Numbness and tingling in the hands and feet

Difficulty walking

Muscle weakness

Irritability

Memory loss

Dementia

Depression

Psychosis

As you say according to the N.I.C.E guidelines loading doses should "continue until there is no further improvement" in neurological symptoms.

google.co.uk/url?sa=t&rct=j...

Click on the link, then on "Scenario: Management" and scroll down.

It is also important that your Folate level is monitored as this is essential to process the B12.

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.

Symptoms of a folate deficiency can include:

symptoms related to anaemia

reduced sense of taste

diarrhoea

numbness and tingling in the feet and hands

muscle weakness

depression

Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.

Do you know whether nitrous oxide will be used as an anaesthetic? This would further impact on your B12 levels so please let the anaesthetist know about your deficiency.

I am not a medically trained person so cannot advise about how long or how many injections you will need before the surgery.

I wish you well

.

[Kerry-78 in reply to clivealive]

I have most of those symtoms

Fatigue, Lightheaded, Palpitations, Shortness of breath, Yellowish skin

You mention folic acid, I take methotrexate for my RA so therfore take folic acid every day apart from MTX day.

Im not sure what the anestetist is using but he does know about the HB level and will tomorrow be told about the B12, it was his decision not to do the surgery last month and again it will be his decision thus time around.

[Gambit62 Administrator]

assuming you are in UK loading doses would be 3x week for 2 weeks - followed by maintenance every 3 months (assuming no neurological involvement - it's more aggressive if there are neurologicalsymptoms).

If you are outside the UK then the regime can be quite different.

B12 isn't toxic so in theory no problems with having it more frequently - though it can interact with the absorption and effectiveness of other drugs - would suggest you discuss that with the RA specialist - though if they have recommended B12 shots it would seem that it is unlikely to interact with the drugs you are currently taking.

[Kerry-78 in reply to Gambit62]

Yes I am in the UK

I had my Dr's appointment this afternoon and was told I would have loading doses, I had one injection and going back Friday for another. The nurse said I can fit 6 injections in before my sugary date which is on the 9th. I asked how long it takes for the levels to go up and her reply was "it will go through the roof quite quickly" I'm hoping this is the case and I've decided to up my intake of ferrous fumarate for the next two weeks to 3 tablets per day to hopefully incerase my HB too as I'm desperate for the surgery to go ahead. I've left a message for my Rhuemy nurse to say I'm having the loading does as I guess she will know more than the GP nurse about it interacting with my other meds.

[Gambit62 Administrator in reply to Kerry-78]

the B12 won't raise your haemoglobin levels - if you had anaemia it will take a few months to recover. Please be careful with the ferrous fumarate and let your doctor know what you are doing as you can overdose on iron.

Yes, your B12 levels will now be off the measurable scale but healing the damage caused whilst you were deficient isn't instantaneous. Some things will improve very quickly but that is about processes being able to run efficiently rather than healing.

[Kerry-78 in reply to Gambit62]

I'm aware that the B12 won't increase my HB, when I had my b12 injection today I asked the nurse if I should up my ferrous fumarate to try and get that up a bit quicker. I said I had read about having too much iron but she said taking more tablets short term would be ok. My HB was 96 last Monday but then I had another blood test last Friday and it had gone down even more to 91.