I was diagnosed as being low in B12 back in August of this year, just by routine blood tests. My reading was 166. One GP I see often, told me over the 'phone I was 'pernicious anaemia'. I had my loading doses of 3 x week for 2 weeks. I had an appointment with the nurse today for another '1off' B12 jab. However on getting there I was told by another GP that I wasn't 'pernicious anaemia' and my next injection would be in February '19. To say I'm confused and slightly let down is an understatement. Do people have any ideas how I can take this forward and what is the normal range for B12 in a 50yr old female! (I also suffer with a underachieve thyroid, which I take regular levothyroxine medication for and I also have 'Degenerative Disc Disease' and have already had my C5/C6 fused back in 2013 and the surgeon won't fuse any more until I start to show more spinal cord damage ie: can't walk, fall over, fine motor skills go, etc etc. Thanks, any information would be greatly appreciated.
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CatsinDevon
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normal range for the test would have been given on the test - there are two separate measures that can be used by labs and they will have different ranges.
However, normal range doesn't mean any point in that range is correct for a given individual - that's not the way statistics work.
There are a number of absorption problems that will lead to a B12 deficiency. As far as I am aware - and assuming you are UK based the protocols are loading + maintenance doses for non-dietary unless the cause is treatable and has been treated (eg h pylori infection treated with antibiotics.
The most likely cause of a non-dietary deficiency is PA - and the test for PA as a specific cause is so flaky that the BCSH protocols (which your GP can access through the BNF) even refer to non-IFAB PA.
It would be useful to understand why the second doctor is stating that it isn't PA - if it is as the result of IFA test proving negative then you need to point out that the test produces false negatives 40-60% of the time (depends on exact test protocol) so a negative is a long way from being solid evidence that you don't have PA. If the reason is that you don't show any signs of macrocytosis then the response is that 25% of patients who are B12 deficient don't present with macrocytosis. Macrocytosis is a symptom of b12 deficiency but it isn't a defining characteristic.
If you have hashimotos then there's a 10-40% chance of going on to develop PA
"on getting there I was told by another GP that I wasn't 'pernicious anaemia' and my next injection would be in February '19"
I suggest it might be worth getting copies of your complete medical files, may be a charge for this. You could then see if a diagnosis of PA has been recorded.
If one GP does not think it is PA , what else do they think is causing B12 deficiency symptoms?
Some GPs do not realise that it is possible to have PA even if the test (Intrinsic factor Antibody) for it is negative. See UK b12 documents below.
If you have B12 deficiency with neuro symptoms, my understanding is that you should have B12 jabs every two months. This applies what ever the cause of the B12 deficiency.
More about UK B12 treatment regimes in BSH, BNF , NICE CKS links in documents list.
Pernicious anaemia is a specific condition where your immune system attacks intrinsic factor or the parietal cells. This leads to B12 deficiency that needs to be treated, usually with B12 injections. There are other conditions which can lead to B12 deficiency, most often malabsorption. This could be caused by Celiac disease, Crohn's disease or a number of other problems. Another common cause is the result of medications for example metformin and drugs that reduce stomach acid, like proton pump inhibitors.
So you can be B12 deficient and not have PA. There are some tests for PA but it often the case where it is diagnosed by ruling other things out in combination with the PA test results. Gambit's post give a good but technical answer to this.
The normal range depends on the testing methodology, the lab will show the expected range with the results. Though once you take B12 supplements like an injection your results will be very high and it won't give a clear picture of what you need.
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