I was diagnosed with b12 deficiency 3 months ago and had a b12 level of 104 (normal range over 130). I had 6 loading doses and after the 6th I found my symptoms subsided (which included neurological). After 6 weeks I felt awful again and went back to gp and asked if I had PA and she basically said it didn't matter as treatment the same (every 3 months). I asked if I could have more frequent injections as I could feel the effects of the injections had warn off and I was using 1200mg of b12 spray everyday. She was reluctant and said she would do more blood tests first and if they were normal she would refer to a haematologist. All blood tests fine but she also retested my serum b12 and it was 600.
So I hope she has made a referral now, but my question is after 6 loading doses and 1200mg of b12 spray 600 is normal, but is it still low?
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Sbmaurice
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Once you start injections further blood testing is pointless. With neuoroligical symptoms you should have had more loading doses and injections every 8 weeks, not 12 weeks. Ask her to check the BNF.
serum B12 measures the amount of B12 in your blood - not how well it is being used by your cells. Its a potentially useful test for diagnosing a b12 absorption problem and, if interpreted properly, for helping to diagnose a B12 deficiency, but it isn't a test that is useful for managing B12 levels after loading shots.
an injection basically puts several years worth of B12 into your blood. The level then decreases, mainly as the excess amount is removed by kidneys - the rate of removal depends on how much B12 is in your blood and is higher if you levels are higher.
However, this is only the level that is in your blood and its no measure of whether you cells are getting enough. A significant number of people seem to react to high levels of B12 in their blood by making the process that allows B12 to get into your cells less efficient and the net result is that some of us need really high levels of serum B12 to make sure enough gets through to cells after loading doses - no clear explanation for this but some interesting research going on at the moment.
National standards have just been changed to be 2-3 months for frequency of injections but as fbirder says, as you have neurological symptoms the BCSH guidelines (which your GP can access through the BNF would be for maintenance to be 8 weekly, though from what you say this still isn't quite frequently enough for you.
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