Feedback please

[MaryF]

Hi guys

Looking at these results.... I think the folate and the B12 is low, would welcome opinions, not my results, for a male friend:

Full Blood Count

Haemoglobin 151 130 - 170 g/L

Mean Cell Volume 93.0 81 - 98 fl

Vitamins

Vitamin B12 193 Deficient <145 pmol/L

Insufficient 145 - 250

Consider reducing dose >569

B12-Active 84.3 37.5 - 188 pmol/L

Serum Folate 22.60 8.83 - 60.8 nmol/L

Thanks in advance. MaryF

[Foggyme Administrator]

Hi MaryF. You're right - according to the reference range quoted, the serum B12 level of 193mmol/L is insufficient. However, the active B12 level (84.3 in the range 37.5-188pmol/L) is at a good place within the range.

However, this is only part of the B12 story because both tests only show how much B12 is in the blood - not how much is being actively processed and used at a cell level - and that's what counts.

Your friend could ask for an MMA blood test to try and clarify whether there is a problem with B12 deficiency. Methylmelonic acid is a by-product of the processes that metabolise vitamin B12 - and if B12 is not being processed properly at a cell level, MMA levels will be raised (though there are other potential causes of raised MMA).

Homocysteine is another test that may help - this will also be raised in the presence of folate deficiency (though folate levels do look okay).

MMA and homocysteine tests aside, both the serum B12 and active B12 blood tests are not particularly effective ways of identifying B12 deficiency - his GP should be looking at symptoms too (not just blood results).

I'm going to post some links below: the first outlining the potential symptoms of B12 deficiency, and then others about the diagnosis and treatment of Cobalamin and Folate deficiencies...and some to do with the problems and issues to do with diagnosis and the common mistakes that many GP's make when dealing (or not) with B12 deficiency.

Many GP's are not well informed about B12 deficiency or Pernicious Anaemia (just one of the causes of B12 deficiency), so they may help your friend decide how to proceed...and provide information that will help him help his GP to help him...if you get what I mean.

Note: it's important that no B12 supplements are taken before all investigation are completed since this will skew any results and make getting a diagnosis practically impossible 😖.

b12deficiency.info/signs-an...

onlinelibrary.wiley.com/doi... in Haematology (BSH) Guidelines: Treatment of B12 Deficiency and Folate Disorders)

onlinelibrary.wiley.com/doi... (UKNEQAS B12 Treatment Alert, Neurological Symptoms and Risk of Subacute Combined Degeneration of the Spinal Cord – Immediate Treatment with B12 Injections)

stichtingb12tekort.nl/weten... (Problems with Serum B12 Test)

stichtingb12tekort.nl/weten... (Testing B12 During Treatment)

stichtingb12tekort.nl/weten... (Misconceptions About B12 Deficiency – Good to Know Before Seeing GP)

stichtingb12tekort.nl/weten... (B12 Deficiency: Neurological Symptoms Can Present Even When B12 is ‘In-Range’ and Without Macrocytosis (large red blood cells) or confirmed PA Diagnosis)

stichtingb12tekort.nl/weten.... (B12 Deficiency and Intrinsic Factor – Can Be Negative and Still Have PA)

stichtingb12tekort.nl/weten... (B12 Treatment Safety / Long Term Treatment for neurological symptoms)

bloodjournal.org/content/bl... (Haematologist B12 Treatment Review March 2017 – Includes Advice No Reason to Advise Against Self-Injection/More Frequent B12 Injections)

stichtingb12tekort.nl/weten... (B12 Deficiency and Neuropsychiatric Symptoms)

gov.uk/drug-safety-update/n... (Low B12 - Nitrous Oxide Contraindications)

ncbi.nlm.nih.gov/books/NBK2... (Gastric Autoimmunity: Heliobactor Pylori)

stichtingb12tekort.nl/weten... (Methylmalonic Acid – MMA)

cdc.gov/nchs/data/nhanes/nh... (Homocysteine Testing Information)

ncbi.nlm.nih.gov/pmc/articl... (No Superior Forms of Cobalamin)

Finally, if your friend has symptoms and is unwell, it's worth noting that there are cross-over symptoms between B12 deficiency and many other conditions - two of the prime culprits being hypothyroidism and diabetes. So, worth ruling out other causes - of which there are many others - if symptoms are present.

Hope this helps...good luck to your friend and please point him in this direction if he needs any further advice or support (or continue to do it for him 😉😀).

P.s. Looks like a lot of reading but most (with the exception of the BSCH Gudelines) only one page long - and worth every word if B12 deficiency is the problem 😉.

[MaryF in reply to Foggyme]

Thank you for your detailed reply, the person in question, a friend is not on B12 but on a pain killer that blocks it, and is in considerable pain.... I suspected this, and thanks, very good information. MaryF (ps I administrate a different forum)

[Foggyme Administrator in reply to MaryF]

Hello fellow Admin...so sorry to hear that your friend is in so much pain MaryF.

If he's on medications that are know to deplete vitamin B12, then he does need B12 injections - he already has levels that are tested as insufficient and levels will drop further unless he is treated.

Be aware - some GP's may offer vitamin B12 tablets. However, in the UK the only tablets licenced for prescription are low dose (50mcg) and these will not be effective for anyone with an underlying cause that prevents the absorption of B12 (they're only suitwble for someone with a dietary deficiency - clearly not the case here).

Here's some information about that:

b12researchgroup.wordpress.... (Serious Caution Note about the use of Oral and Sublingual B12 Supplements)

I hope his GP is not one of those who mistakenly think that B12 levels have to register as deficient before injections are required. As per above (and all the guidelines), treatment should be based on symptoms.

In addition, if he has neurolgical symptoms, he should have the intensive B12 regime of injections (6 x loading doses on alternate days and then injections every other day until there is no further improvement (as per the BNF guidelines in the link above). Not many GP's have heard of this so he will need to take evidence to show the GP, just in case (if he has neuro symptoms).

Hope all goes well and that he gets the B12 treatment he needs...post again if he needs more help or advice.

👍