Enlarged Red Cells

[NannaTV]

Hi I am new here, I was diagnosed with low B12 (110) in 2016, I had no idea what it what it meant, The GP advised it was life changing and I needed to start B12 loading doses and 12 weekly thereafter, Hating needles, I asked if there was another path to take, She said we could try Folic acid for 3 months and then re test, Had I known then what I know now and the fact my health was so bad I could not even walk upstairs by the end of it plus all the other symptoms. I would have stated them straight away! After the three months my B12 had gone down to 105. I started loading straight away then every twelve weeks but it was not enough after several trips back to GP I am now on 6 weekly but this is still not enough, The GP has said I cannot have any more due to my red cell being to enlarged and wants me to see a tummy doctor (GP’s words) to see why I am B12 deficient. I also take Folic Acid 5mg daily as Iron levels are low. Haematicrit level at last test was 0.513.

My question is this as I am now Self injecting thanks to all the good advice on here am I in danger of causing more problems due to the enlarged red cells? In my mind if it is caused by B12 then if I get the levels right wont they reduce?

Any advice appreciated.

[wedgewood]

No , your self-injecting is not exposing your to more problems with your enlarged red blood cells. I think that 5mg of folic acid daily is really excessive. It’s not good to have so much daily and long -term . I would think that 400 mcg is sufficient as you are sure to be obtaining some folate in your diet . I’m surprised that your GP hasn’t tested you for PA with an IFA test (Intrinsic Factor Antibody ) It is unreliable if you test negative, but totally reliable if you test positive . ( can be obtained also from Medichecks ) . No harm in going to see a Gastroenterologist ( or tummy doctor, the words that your GP used ) He/she can put a camera in your tummy and find useful information . My gastroenterologist told me that PA patients have low/no stomach acid Hypochlorhydria/Achlorhydria, which can also cause problems with absorption of vitamins, minerals and other issues . You cannot overdose on vitamin B12,, So nothing to worry about with that. Best wishes .

[NannaTV in reply to wedgewood]

Thank you for the advice I will continue to SI and wait for the appointment to come through and see what happens.

[fbirder]

Idiot doctor alert.

There are two main causes of large red cells - a deficiency in either B12 or folate. So taking B12 is a cure, not a cause, for enlarged red cells.

5 mg (5000 mg) of folic acid is a hell of a lot. It’s the sort of dose you should take when initially diagnosed with low folate. It’s like a loading dose. But after a few weeks you should drop down to around 400 mcg a day.

Taking folic acid will have zero effect on iron levels. You need to take iron for that. Try Gentle Iron as that’s easy to absorb.

A gastroenterologist may be able to say why you’re not absorbing B12. But that should be irrelevant as you’re having injections - which bypass the absorption process.

You need to find out why you have large red cells despite lots of folic acid and B12. The person to investigate that is a haematologist.

[NannaTV in reply to fbirder]

Hi. I have been concerned about taking the folic acid for so long I am going to book to see the GP and ask her to re test my iron levels and ask for a IF test and any others that may help. I saw a haematologist when first diagnosed and he done lots of test and said he could find no reason for enlarged cells and was not concerned and said to refer me back if it goes over 0.54 which it hasn't. The letter also states that it's due to haemoglobin not B12 deficieny Really appreciate the advice it so confusing when GP hasn't got enough knowledge. Thank you

[fbirder in reply to NannaTV]

I’m not sure what you’re referring to when you say ‘over 0.54’. Red cell size is normally given in fl and range about 90 to 100 (ish).

[NannaTV in reply to fbirder]

It's the figure he wrote on letter to GP think it may be the haemocratic level

[NannaTV in reply to NannaTV]

Sorry that's haematocrit level

[fbirder in reply to NannaTV]

I thought as much.

Ask for your blood test results and look for the MCV (mean cell volume) and, if they measured it, the RDW (Red cell Distribution Width).

A high MCV (more than 100 fL) and low RDW (less than 14) suggests macrocytic anaemia.

A low MCV (less than 80 fL) suggests microcytic anaemia, normally caused by iron deficiency.

An average MCV with a high RDW (more that 15) suggests both types of anaemia. The small cells and the large cells give an average volume, but with a large distribution.

But any anaemia would normally be accompanied by a lower than normal haematocrit. labtestsonline.org/tests/he...

[NannaTV in reply to fbirder]

Hi, I have access to my bloods online, I do not seem to have had those ones done should I ask for them to be done? These are what I can see.

Mean corpusc. haemoglobin(MCH) 33.9 pg 27 – 32Abnormal

GFR calculated abbreviatd MDRD56 mL/min/1.73 m2 > 60 Abnormal

Haemoglobin estimation 176 g/L 115 – 165Abnormal

Serum folate2.4 ug/L4.6 - 18.7Abnormal

Serum creatinine (kidneys) 91 umol/L45 – 84Abnormal

Regards

[fbirder in reply to NannaTV]

So you have low folate, but slightly high levels of haemoglobin.

Was that folate test done before you started 5 mg of folic acid?

[NannaTV in reply to fbirder]

Yes Gp then said Folic Acid and may need to always take it.