Lab results - PA?

[reflected_glory]

Hi,

Since this April I've been dealing with depression, anxiety, and starting in July I experienced extreme fatigue (couldn't sit up at my work desk) and passing out when standing for than 10 minutes. I thought the fatigue was a result of the depression and the fainting was because of the fatigue but I started to get out of breath walking small distances. Then the heart palpitations and chest pain began and I got worried. I went to the doctor and EKG came back okay, just tachycardia (elevated heart rate) and blood work was ordered. Within two hours my Dr called and mentioned possible blood transfusions. Additional tests were ordered and below are the results. I've since began loading doses of B12 - I'm in the States so 1000mg every day for a week, then once weekly.

I don't see my Dr for two weeks, but the MMA and LD are concerning me. Should I just be lucky to be alive? Normal ranges are in parathensis.

RBC 1.78 (4-5.2)

Hemoglobin 6.9 (12-16)

HCT 19.8 (36-47)

MCV 111 (80-97)

MCH 38.8

RBC width 17.4

B12 less than 147 which means per my Dr it was undetectable

Haptoglobin less than 8

Homocysteine 92.1

Positive for intristic factor antibodies

LD 1278 ( 171-309)

MMA 5950 (87-318) yes that's almost 6000. Per the lab notes, it was tested twice.

[wedgewood]

Welcome to PAS ! You will have very elevated levels of B12 now . Do not worry , about your high MMA readings —you cannot overdose on B12 . There is scientific evidence for this if you need it . You need to get your homocysteine levels down .about 7 would be ideal .. That will happen because you are being treated with B12 injections and I assume that you are taking supplements of folate/folic acid,(vitamin B9) .But it’s a good idea to take a combined multivitamin and mineral tablet . You have Pernicious Anaemia which means you will have low/no stomach acid ( Hypochlorhydria/Achlorhydria. You need stomach acid to help absorb vitamins and minerals from your food , so it’s good to supplement with a modest tablet . I find that a good probiotic helps any tummy pain etc that accompanies low stomach acid . , which can upset the flora in the stomach .

You have an autoimmune condition . The Antibodies you produce attack the parietal cells in your stomach . These cells produce stomach acid and the Intrinsic Factor . Both are needed to absorb vitamin B12 , which is the most difficult vitamin to absorb . B12 is needed to form the myelin sheath of all the nerves in the body , and to form the red blood cells correctly .So PA has a myriad of symptoms . It they will disappear with correct treatment . Glad you got a correct diagnosis . Recovery will not happen quickly if you have been deficient for a long time . Be patient though . Bear in mind that auto-immune conditions rarely come alone .Most commonly they come with thyroid problems . I have mild rheumatoid arthritis. But there are others of course . . You have come to the right place here . You will learn a lot just from reading the posts . You will find that many people here in the U.K. have difficulty in getting sufficient treatment because doctors here only want to give an injection every 3 months after loading doses . For some patients that’s sufficient , for some not . , I have to self-inject to keep well , which means I have to get my B12 ampoules(Hydroxocobalamin) from German on line pharmacies, as injectable B12 is only obtained on prescription here , just like in the US . I inject weekly . Some patients daily . etc We are all very different ! You have come to the right place here . There is always someone who will try to help you if you have a question . Best wishes .

[clivealive Forum Support]

Hi reflected_glory I don't see your Folate level in your list above.

It is important that your Folate level is monitored as this is essential to process the B12.

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Symptoms of a folate deficiency can include:

symptoms related to anaemia

reduced sense of taste

diarrhoea

numbness and tingling in the feet and hands

muscle weakness

depression

Initially, replacing B12 will lead to a huge increase in the production of blood cells and platelets (which occurs in the bone marrow) and can lead to rapid depletion of folate and iron stores; this can then limit the expected recovery of Haemoglobin.

Both iron and folate may be needed so please have these levels checked by your doctor.

I'm guessing that as you are in the States your injections are cyanocobamalin - the same as I am even though I'm in the U.K.

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

.

I am not a medically trained person but I've had Pernicious Anaemia (a form of B12 deficiency) for more than 46 years and I'm still "clivealive" aged 77 :).

I wish you well.

[fbirder]

You have Pernicious Anaemia.

One of the symptoms of PA is macrocytic (large cell) anaemia. That's why your MCV (Mean Cell Volume) is so high. These cells aren't as robust as normal red cells which is why your LD (lactate dehydrogenase) is so high. This is raised in any situation where cells are getting damaged.

I suspect you may also have iron-deficiency anaemia because your RDW (Red cell Distribution Width) is so high.The RDW is a measure of the range of red cell sizes. On average your red cells are large, but you have a wide range of widths. IDA causes small red cells. So if you have both the range of widths is large. Also your haemaglobin levels are low. Your doctor will probably prescribe iron tablets. Make sure they aren't iron sulfate as that's hard to absorb. You want iron fumarate or bisglycinate.

MMA and homocysteine are two chemicals used up in reactions mediated by B12. If you are low in B12 then these compounds will accumulate - as they have in you. Now you're being treated right their levels should drop.

High hCys can also be caused by low folate. If you didn't get yours checked then you might want to do so.

Good luck

[Gambit62 Administrator]

High MMA and high LD are consequences of B12 deficiency. The MMA should correct very quickly and is probably okay if you have been on daily injections for a few days.

LD and MMA can be elevated by other problems but if you were started on B12 then that would imply that long standing B12 deficiency is the cause.