Normal ranges

[Sbmaurice]

Hi I got my b12 level which was 104 and the range was 130-900. The nurse said my level wasn't very low. Is the above a really low range as I've read other posts where the range is 200-900?

[clivealive Forum Support]

Hi Sbmaurice

On those readings you are B12 deficient and should be treated.

What symptoms do you have?

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

Do you know your Folate level?

I am not a medically trained person but I've had Pernicious Anaemia (a form of B12 deficiency) for more than 46 years.

I wish you well.

[Sbmaurice in reply to clivealive]

My folate was normal, but i didnt get thr level and I would say tiredness, pins and needles in hand and feet, lightheadedness and sudden onset diarrhea.

[Foggyme Administrator]

Hi Sbmaurice.

Your nurse is talking nonsense.

Your B12 level is 104 and the reference range used for your test is 130 - 190 so your B12 level result is far below the 130 (bottom of the range). This is a clear indication of B12 deficiency and you should therefore be treated for B12 deficiency.

About reference ranges, in general:

There are several different ranges that labs use - different countries tend to have different preferences.

Units for measuring B12 are:

133 - 675 pmol/L (picomole per litre)

200 - 900 pg/ml (picogram per litre)

180 - 914 ng/L (nanograms per litre)

But Note: these are general ranges only and each figure at both the bottom and top end can be altered significantly when calibrations for testing equipment and local statistical averages are applied - so the ranges above cannot be used to interpret your results.

Your results should only be interpreted within the reference range applied by the lab and listed on your results report (i.e. they can't be interpreted by reference ranges quoted elsewhere - including those I've listed above).

There is no such thing as a baseline that GP's use when testing B12 (and the numerical values for serum B12 and active B12 are very different). To make it more difficult, the reference ranges used varies across labs, since these are calibrated differently for different pieces of equipment and according to local statistical averages.

What matters is that whatever test you had (serum or active) should include the applicable reference range after the test result (the reference range is the two figures that follow the result (i.e. test result 75 with reference range 69 - 450).

Having said all this, all B12 testing is notoriously inaccurate - you can be within the 'normal' range and still be B12 deficient. Or be lower then the range, and be okay.

So what matters is symptoms - if you have the symptoms of B12 Deficiency (with no other discernible cause), then a GP should look at the whole clinical picture - and treat the symptoms, not the blood test results. This is particularly important if neurological symptoms are present, since early treatment is important for optimal recovery and to prevent potentially irreversible neurological damage (though certainly not suggesting that you have - or will get this).

Having said all this, you have a blood test result that clearly indicates B12 deficiency - and you should be treated for this.

In the UK the treatment for those without neurological symptoms is 6 x loading doses given over two weeks and then injections every three months.

For those with neurolgical symptoms, following the loading doses, injections should continue every other day until no further improvement (not many GPs know this).

To get you started, here are links to the BSCH diagnostic and treatment guidelines

for cobalamin and folate deficiencies (what your GP should be following to investigate the cause of your deficiency, diagnose and treat you) and the BNF, which details the two different treatment regimes (one for those withou neuromsymtpoms and one for those with).

bnf.nice.org.uk/drug/hydrox...

(BNF B12 Deficiency: Hydroxocobalamin Treatment Regimes)

onlinelibrary.wiley.com/doi... (British Committee for Standards in Haematology (BCSH) Guidelines for the Diagnosis and Treatment of Cobalamin and and Folate Disorders)

Sincerely hope that you are being treated for your obvious deficiency.

B12 deficiency can be very complex and GPs and other health professsional are often ill-informed so please post again if you need more help or advice.

Good luck 👍

[Sbmaurice in reply to Foggyme]

Thank you very much for the advice! I just had my 3rd loading dose this morning, 3 more to go then every 3 months. I think I felt a bit like a moaner after she said it's not very low. Some medical professionals can be very short about things that can impact significantly on your life

[clivealive Forum Support in reply to Sbmaurice]

You didn't mention in your original post that you were already being treated with B12 injections.

Be aware that it is not uncommon for some symptoms to appear to get worse before they get better as the B12 you are having starts repairing the damage done to your nervous system and your brain starts getting multiple messages from part of the body it had "forgotten about" or lost contact with.

I sometimes liken it to a badly tuned radio on which you have turned the volume up high trying to catch the programme you want when all of a sudden the signal comes in loud and clear and the blast nearly deafens you.

A lot will depend on the severity and longevity of your B12 deficiency as to how long before there is no further improvement or recovery.

Some symptoms will "disappear" quite quickly whereas others may take months or even years.

There is no set timescale as we are all different.

[Foggyme Administrator in reply to Sbmaurice]

That’s great Sbmaurice.

Just be aware that if you have (or had) neurolgical symptoms, then three monthly,injections after the loading doses is not the prescribed treatment in the UK. You should continue to receive every other day injections until no further improvement. (Details in the BNF link above).

If you find that your symptoms return before your three month injection is due, this is a clear indicator that you need more frequent injections. The aim is to have injections frequently enough to stop symptoms returning before the next injection is due.

Agree about medical professionals being very 'short', especially where B12 deficiency is concerned. They just don't understand what the symptoms are. Nor do they understand the devastating impact B12 deficiency can have on those who have it. Sad and bad.

Hope you begin to feel better soon and post again if you need more information about getting more frequent injections (if you find you need them).

👍

[RJGFiona in reply to Sbmaurice]

Hi, I can empathize with you I to have just had my 3rd injection and I haven't been told what any of my levels are just that B12 was low and I will be on the injections for life. I was going to ask yesterday but the nurse was so busy and behind I didn't want to make her day worse. I to feel as if I might be perceived as a a moaner but I have loads of questions. I hope you feel better soon x

[Sbmaurice in reply to RJGFiona]

It's so difficult isn't it, I just wanted to be told exactly what's going on. If it wasn't for PAD and this forum I would have now clue

[RJGFiona in reply to Sbmaurice]

I know if it wasn't for this site I wouldn't have a clue. I will try and ask for my results in Monday. Good luck with your injections x

[Sbmaurice in reply to RJGFiona]

You too x