ADVICE HELP NEEDED

How do I know or find out if I have anemia? I’m convinced I have it. I already have a underactive thyroid which I take 150mg per day of Levothyroxine Doctor has tested my b12 428 and folates 2.1 due to my symptoms I have very bad memory can’t think straight forget things all the time even putting the handbrake on car which has caused me 2 crashes my body aches daily I can’t walk properly every couple of days I wake up and have what I call a bad day where I’m so tired extremely weak I can’t hold a cup properly I feel so helpless an like I’m 80 years old I’m only 27 the doctor has told me my folate is low and if I take folic acid eat greens all this will go away but I have started and not convinced

[Dadvatar]

I’m not a Dr but I think anemia is diagnosed from the lab looking at your red blood cells. Pernicious anemia from what I understand is hit and miss when it comes to testing as the tests are unreliable. The GPs should take into account the symptoms when making a diagnosis, but good luck with that as most don’t understand/not interested in B12 Deficiency. A trial of B12 may be sensible as it can cause no harm but I’ll eat my hat if you can get an NHS Dr. To offer you them on those results.

My daughter had results of 127 and they still would not entertain treatment.

[Gambit62 Administrator]

I presume you are talking about a diagnosis of B12 deficiency but the following covers B12 deficiency and iron deficiency in relation to anaemia. PA is one possible cause of B12 absorption problems - and there are a few ways that hypothyroidism could result in absorption problems for various minerals.

the symptoms of folate deficiency and B12 deficiency overlap considerably. Your B12 result is actually well into the normal range and whilst it is not possible to entirely rule out B12 as an issue it is extremely unlikely that you are currently B12 deficient.

If your hypothyroidism is due to hashimotos then there is quite a significant cross over with PA. PA is actually an auto-immune condition that affects the ileum basically destroying the mechanism by which you absorb most of your B12. The ileum is also where most of your folate is absorbed.

There is quite a wide variation in the normal range for B12 which means it is quite difficult from a single reading to be able to say if the levels are correct for you. Normally your B12 levels are regulated by releasing stores in your liver but if you have PA this mechanism doesn't work anymore so B12 levels start to drop. This tends to happen very slowly over a period of years or even decades as the absorption problem gets worse. Serum B12 is potentially a useful test for diagnosing an absorption problem but this means identifying significant drops over time. As the test has an error of about 20% (the variation you will get from doing the test on the same sample) this means consistently seeing levels dropping by more than 20% over a period of time. So, a single measure isn't particularly helpful.

If your folate deficiency definitely isn't dietary then it would be an absorption problem - and because both folate and B12 are mainly absorbed in the ileum this means that a folate absorption problem is likely to mean a B12 absorption problem.

source to back this up is the BCSH guidelines on diagnosis and treatment of folate and B12 deficiency.

onlinelibrary.wiley.com/doi...

your GP can access this through the BNF.

Absorption problems are quite common with hypothyroidism, though iron is the one that generally manifests first. This results in smaller red blood cells, which can mask the macrocytic anaemia that is characteristic of B12 deficiency (larger rounder red blood cells). This is likely to lead to quite a quite a wide distribution of cell sizes which would show up as a high RDW.

25% of people with B12 deficiency present without macrocytic anaemia so absence can't be used to rule out B12 deficiency.

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Have blood test results which ones do you need to look at