Help with understanding test results?

[pj16]

Hi everyone. In the last 18 months I have had many strange (and as yet undiagnosed) symptoms. Too many to list on here and not bore you all to death but my main worries are leg pains (intermittent claudication), leg weakness/pain, tingling hands/feet, fast heart rate when walking, left sided chest pain, stomach pain etc etc! I've seen a vascular surgeon who has ruled out peripheral artery disease. I also saw a cardiologist who diagnosed moderate coronary artery disease. I am on medication for this but the cardiologist felt that he couldn't link all of my symptoms to the level of artery disease. I'm considering ordering private blood tests as all of my symptoms are having a big impact on my daily life. My GP will not test further than Serum B12. Here are my recent blood results and I'd welcome and appreciate any comments.

September 2018

Erythrocyte sedimentation rate 5 mm/hr (2 – 16)

Serum vitamin B12 177 ng/L (145 – 910)

Serum free T4 level 10.3 pmol/L (7.0 – 17.0)

Serum TSH level 2.32 mu/L (0.20 – 4.50)

HbA1c level – IFCC standardised 31 mmol/mol (20 – 41)

Se CA 125 level 7ku/L (0 – 34)

Serum creatinine kinase level 76 iu/L (25 – 200)

Serum gamma GT level 9 iu/L (10 – 53)

Serum ALT level 15 iu/L (10 – 50)

Serum total bilirubin level 7 umol/L (0 – 21)

Serum calcium 2.41 mmol/L (2.20 – 2.60)

Serum albumin 39g/L (35 – 50)

Serum adjusted calcium conc 2.43 mmol/L (2.20 – 2.60)

Serum inorganic phosphate 1.15 mmol/L (0.80 – 1.50)

Serum alkaline phosphatase 47 iu/L (30 – 130)

Serum sodium 143 mmol/L (133 – 146)

Serum potassium 4.7 mmol/L (3.5 – 5.3)

Serum urea level 4.5mmol/L (2.5 – 7.8)

Serum creatinine 66 umol/L (50 – 100)

eGFRcreat (CKD-EPI)/1.73 m*2 90mL/min/1.73 m*2 (60 – 150)

Serum C reactive protein level 1 mg/L (0 – 7)

Rheumatoid factor 10 kiu/L (0 – 14)

Plasma fasting glucose level 4.8 mmol/L (3.5 – 6.0)

Haemoglobin estimation 129 g/L (115 – 165)

Total white cell count 4.6 10*9/L (4.0 – 11.0)

Platelet count 195 10*9/L (150 – 450)

Red blood cell (RBC) count 4.12 10*12/L (3.80 – 5.80)

Haematocrit 0.381 L/L (0.360 – 0.470)

Mean corpuscular volume (MCV) 92.6 fL (80.0 – 100.0)

Mean corpusc. haemoglobin(MCH) 31.2 pg (27.0 – 32.0)

Neutrophil count 2.58 10*9/L (1.70 – 7.50)

Lymphocyte count 1.42 10*9/L (1.00 – 4.00)

Monocyte count 0.41 10*9/L (0.20 – 0.80)

Eosinophil count 0.14 10*9/L (0.04 – 0.40)

Basophil count 0.04 10*9/L (0.00 – 0.10)

Nucleated red blood cell count 0.20 10*9/L N/A

January 2018

Serum vitamin B12 180 ng/L (145 – 910)

Serum folate 13.9 ug/L (3.0 – 20.0)

March 2017

Serum 25-Hydroxy vitamin D3 level 40.1 nmol/L N/A

Serum vitamin D2 level less than 10.0 nmol/L N/A

[Gambit62 Administrator]

Your B12 results are certainly in the grey area - and the difference between the two results isn't significant in terms of the accuracy of the test.

Suggest you draw your GPs attention to the BCSH guidelines on diagnosis and treatment of cobalamin and folate disorders which they can find on the BNF but can also be here.

Main areas to draw to their attention are

a) 25% of people presenting with B12 deficiency don't have macrocytosis

b) the limitations of serum B12 are such that using the results as an absolute measure will result in missing 25% of people who are deficient, so symptoms are important.

c) neurological symptoms need prompt treatment to prevent further damage

Also provide a list of symptoms (but be prepared for GP to tell you that half of them don't relate to B12!

pernicious-anaemia-society....

[deniseinmilden]

It could easily all be explained by the low B12, especially as it has been low for a while.

Please see replies to other posts by Sleepybunny who has retired as an admin but has previously posted a wealth of knowledge on how to get treatment from reluctant GPs.

B12 Is very safe and well worth trying.

Do not supplement until you have persuaded them to give you a course of 6 every other day "loading dose" jabs in case you blood levels are tested again.

Let us know how you get on! Good luck!

[pj16]

Thanks to both of you. I took the bull by the horns and ordered a blood test kit from Medichecks to include active B12, folate, ferritin, vitamin D etc. My thinking is that if these results shed any light on possible deficiency my GP might be prepared to test further or prescribe treatment. I have another question. I noticed in my blood results that nucleated red blood cell count was 0.20 10*9/L (no reference range given). I read somewhere that this count should always be zero. Could anyone advise?

[Gambit62 Administrator in reply to pj16]

tests have their limitations - one of which is that they can have problems distinguishing between molecules that have a similar weight - this is one reason why the IFA test does have a range that doesn't start with zero.

Long way from being an expert in the tests that you mention so couldn't be sure that this is the case for this test. Suggest you speak to the lab that did the test.

[Lyntwo]

Are you in a position by which you can inject yourself with B12? Perhaps this may be what you will need to do. You do not have to reply to this. It is just a suggestion. I have to do so here in the USA, where B12 shots are still regarded as a sign of quackery.

[pj16]

Hi Lyntwo. I may have to resort to that but will await further blood results.

[Martin_12]

I am not medically trained, but a Google search for "nucleated red blood cells" indicates that a non-zero nucleated red blood cell count can indicate serious disease. There are a number of possible causes:

academic.oup.com/labmed/art...

(click the PDF link to get the full text)

It may be helpful for you to see a haematologist.

B12 deficiency can cause the appearance of nucleated red blood cells, so MMA and homocysteine tests may be helpful.

ncbi.nlm.nih.gov/pubmed/182...

[Foggyme Administrator]

Pj16.

I've left a reply about your blood test results on your previous post.

healthunlocked.com/pasoc/po...

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