Pernicious Anaemia Society
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Blood Count Results

I’m 22. I had blood tests done in my last pregnancy in August, as they said I had oversized blood cells. I was B12 deficient in my last pregnancy, I had three injections in three weeks the last one being in October. I also had pre-eclampsia in my first pregnancy but not sure if that’s related at all. I didn’t have these blood tests done in the first pregnancy.

My mum has hashimotos disease.

I’ve had a few strange symptoms such as pins and needles in my feet and toes which has been especially noticeable. I am extremely clumsy, I’m quite uncoordinated and shakey with my hands. I do not seem to heal, I’m very pale and even the tiniest scratches scar. I also have very dry skin.

Can you help understand these results please? What should I do next?

These are my results from two weeks ago:

Serum TSH Level - 2.82mu/L (0.35-5.0)

Serum C Reactive protein level - (PR) - normal - no action 1mg/L <7

Blood haematinic levels - (PR) b-12 ok; folic acid sl low

Serum vitamin b12 236 ng/L (130-800)

Serum folate 3.5 ug/L (4-20)

Serum ferritin 25ug/L (12-250)

Haeomoglobin estimation 139g/L (120-160)

Total white cell count 8.6 10*9/L (4.0-11.0)

Platelet count 304 10.9/L (150-400)

Red blood cell count 4.48 10*12L (3.80 -5.80)

Haeomatocrit 0.418 L/L (0.350-0.450)

MCV 93.3fL (80-100)

MCH 31.1pg (27.0-32.0)

MCHC 333g/L (300-358)

Red blood cell distributor width 14.2 (11-14.5)

Mean platelet volume 8.7 (6.5-20)

Neutrophil count 5.3 10*9/L (2.0-7.5)

Lymphocyte count 2.2 10*9/L (1.5-4)

Monocytes count 0.6 10.9*/L 0.2 -0.8)

Basophil count 0.1 10*9/L (0.0-0.1)

Eosinophils count 0.4 10*9/L (0.0-0.4)

Thanks! 😊

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TSH is a measure of thyroid function - hormone produced by the pituitary gland to encourage the thyroid to produce more hormones - it's a secondary measure of thyroid function so doesn't tell the whole story. Labs tend not to measure thyroid hormones T3 and T4 unless TSH is outside the normal range. Yours is well within the normal range which implies that there isn't anything thyroid going on as you aren't being treated for hypothyroidism. (Treatment for thyroid impacts on the results and most people on treatment seem to need TSH to be towards the bottom of the range to feel well - the treatment just introduces a new factor that skews things).

Your folate is low - folate is quite responsive to dietary in take so first question would be about how much you have in your diet/are you supplementing? if the answer is that you have good amounts in your diet and/or supplement then that would imply you have an absorption problem.

Your B12 is in the normal range but it also takes a very long time for B12 to drop. Given that you had injections in October that would have put your levels well above the measurable range and now they are quite low. This, combined with your symptoms and the low folate levels would point towards a B12 absorption problem.

B12 in pregnancy is quite a difficult area and I'm not sure what the protocols are on treatment - and I'm also not clear what country you are based in as protocols also vary from country to country.

Although your blood work doesn't currently show signs of macrocytosis (one classic symptom of B12 deficiency and folate deficiency) this isn't present in 25% of people who present with B12 deficiency so shouldn't be used to rule out B12 deficiency.

Protocol in the UK for treating someone presenting with neurological symptoms and indicators of B12 deficiency is to give symptoms precedence over serum B12 levels and to give loading shots (1000mcg hydroxocobalamin) 3xweekly for 3 weeks until symptoms stop improving followed by maintenance every 2 months (100mcg hydroxocobalamin).

The most likely explanation is that you have PA (an auto-immune condition that attacks the mechanism that allows your gut to absorb B12 from your diet - this can also affect other vitamins and minerals - such as folate and iron. The test for PA is, unfortunately, like serum B12 - not gold standard and produces false negatives 40-60% of the time so whilst it is good at showing you do have PA if it comes back positive it's a long way from showing that you don't have PA if it comes back negative.

Some of your iron measures are towards the low end of the scale so I'd be inclined to suspect that you are borderline on iron deficiency as well. Iron deficiency results in smaller red blood cells - B12 and folate deficiency result in larger red blood cells - so if both are going on then reading test results becomes very difficult - your RDW is in the normal range but is towards the top which for me would reinforce the possibility that you are borderline iron deficient as well as folate deficient.

I'd suggest you go back to your doctor and ask for treatment - start B12 24-48 hours before starting the treatment for the folate acid, and look further into the possibility of iron deficiency.

I'm not a doctor but I'm also aware that doctors generally don't understand how mineral and vitamin deficiencies work and have a tendency to over-rely on clear results from blood tests rather than talking to their patients to get the whole picture. They often don't understand how B12 deficiency works and think it is all about serum B12 levels and macrocytosis - it is a lot more complicated than that and people can be B12 deficient but have serum B12 levels well into the normal range.

If your GP wants to do further tests then MMA would be the one to go for - will be significantly raised if you are B12 deficient - but it can also be raised by other things so needs to be done with a kidney function panel

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Yours is well within the normal range which implies that there isn't anything thyroid going on as you aren't being treated for hypothyroidism.

I sort of agree - in that it is well within range and would never be treated by a doctor. At the same time, I'd point out that my first TSH test was about 2.1, and that was done due to symptoms possibly due to being hypothyroid. Over the next months, TSH tests were repeated and it went up steadily. Eventually, with diagnosis at just over 5 and taking adequate levothyroxine, those very symptoms resolved.

My suggestion would be to get re-tested and see what happens over time. Or, if possible, get Free T4 and Free T3 tests done.

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Thank you for your replies I will show them to a doctor and ask for the further tests. 😊

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on thyroid would suggest T3, T4 (free at least, total as well if possible) and antibodies. 40% chance of developing Hashimotos (auto-immune thyroidosis) if you have PA - and similar the other way round.

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