Pernicious Anaemia or not?

[Sagittarius]

I'm new to this forum and PA and wondered if any one could some ideas.

My mother who is 86 has been suffering from fatigue and unsteadiness for some months. She has vitiligo which appeared 6 years ago.

I questioned her GP about potential PA and was told it could not as her B12 serum result was ~600. We did a private test for active B12 and this was 132 in the "normal range".

She does have other health complications such raised blood pressure and a heart valve replacement, but has had a heart monitor plus other blood tests which have revealed nothing.

So should we dismiss PA as a potential cause?

If not how can PA be confirmed or otherwise?

Many thanks...

[wedgewood]

There is no doubt that one can have a normal B12 reading , and still have PA .There is a document somewhere stating this , but I don’t know how to access it . It is a fact also that the older one gets , the less stomach acid that one produces , which leads to poor B12 absorbtion .

I rather suspect that quite a large proportion of older people would benefit from B12 injections , which would help them physically and mentally . Also very cheap . Also important is sufficient B9( folate /folic acid ) which works together with B12 . So make sure your mother gets either plenty of green leaved veg or takes a 400 ug supplement .

[clivealive Forum Support]

Hi Sagittarius I wonder why your Mother's serum B12 level was so high unless she has been given supplements of one form or another.

[Gambit62 Administrator]

Sagittarius, the results you quote are both well into the normal range (not sure if the serum may be above normal range). This means it is extremely unlikely that your mother has a B12 absorption problem.

There are two units that are used to measure serum and active B12 and they have different ranges so important to include ranges when giving results.

PA is an auto-immune of the gut that attacks and destroys the mechanisms that allow your body to absorb most of the B12 it gets from food. Generally the body regulates levels of B12 in blood very well using stores in the liver but releasing these stores relies upon the same mechanism that absorbs most B12 so the process will be very efficient if you have a B12 absorption problem and levels will fall. So, a single measure of B12 may not reveal an absorption problem if your personal normal level is high in the range - but two or more measures over time showing significant drops (>20% can indicate an absorption problem going on)

If the results are above the normal range then it is possible that there is the possibility of a functional B12 deficiency - significant numbers of people respond to high serum B12 levels by making the mechanism that allows the B12 to get into your cells much less efficient, leaving the cells without all the B12 they need to run all the processes they need to run. If this is the case then homocysteine and MMA levels would be high - but both of these need to be looked at in a context that rules out other reasons why they might be high, eg folate deficiency in the case of homocysteine and kidney problems in the case of MMA. A liver and kidney panel would be a good idea if levels of B12 are above range as raised B12 can be an early sign of liver and kidney problems.

Were your mothers thyroid levels checked. There are similar problems interpreting thyroid results - particularly TSH - to those using serum B12 as an indicator of problems - suggest you explore that on the TUK forum

healthunlocked.com/thyroiduk

[Sagittarius]

Many thanks for your replies, I really appreciate your comments and suggestions.