Low B12 level.

[lucylocks]

Hi

My son in law has been really depressed and anxious for a few months now.

He has palpitations and is sweating, is irritable, and very self conscious, not sleeping very well, and has lost his appetite.

For the past year he has had really bad diarrehea but since cutting out lactose this has improved.

His Doctor did some blood tests and all his vitamin levels came back low, especially B12 which was 140 bottom of range 115.

His folate is also low.

The doctor said he could not do anything about the low B12 as it is in range and gave him anti depressants which he has been taking for about six weeks now. He went back to the doctors this week as he is not feeling any better and he increased his A.D. dose.

The doctor admitted his B12 was low. Son in low told him he had started taking B12 supplements, 1000mg daily and doctor said come back in a month and if the level had not gone up he will see if he can do something about.

I have posted on the thyroid forum as he had his thyroid levels tested and the advice I received what that they did not think he has a thyroid problem. One member kindly gave me a link to our local health authority guidelines and it states if B12 is below 150 and you have symptoms then further test should be done and injections started, which obviously his doctor has not followed.

Both his parents get B12 injections but I do not know if they have P.A. .

Can anyone advice what he should do now. If he goes to the doctor and ask to test for P.A. will the supplements he has been taking have an effect on this.

Any advice would be gratefully received.

Thank you.

[Nackapan]

I would push for the B12 injections. It doesn't matter he has taken supplements as they have a blood test result. I thought 'the norm' is 200-900 and that is what's in your system and not all active. That's as accurate as that test is. He has so many symptoms. I personally recognise the sweating , palpitations and low mood amongst many other symptoms that developed. I I initially was prescribed ant depressants and was told I had panick attacks. This can often be the case. I didn't take them as knew I was not. It was only then they did a blood test.

Surely all the vitamin and folate defiencies shoukd be supplemented and hopefully he will retain then now his diarrhoea better. Poor man. He is too low to sort this himself. Hope he gets the treatment he needs

[lucylocks in reply to Nackapan]

Hi

many thanks for your reply.

The bottom of the range here is very low at 115, top of range 1000

Sorry you were having the same symptoms and hope you are feeling better now.

I think he must go back to the doctor and insist on the injections as he is not feeling any better but he seems reluctant to, but like you say he is too low to sort himself out.

I will get my daughter to push for him to make another doctors appointment.

Thank you once again.

[Nackapan]

I do hope the anti depressants are helping him. They do take a while to kick in normally. Perhaps they will help him take charge ato this stage.

[Gambit62 Administrator]

The test for PA - IFA is notoriously insensitive and gives false negatives 40-50% of the time. Generally it doesn't give false positives, though doing the test too close to supplementation can result in false positives (how long since last supplementation depends on the exact test protocol - but can be up to 2 weeks).

I would recommend pointing your sons GP at the BCSH guidelines on diagnosis and treatment of cobalamin and folate disorders which they can access through the BNF

This is a link to a version of the guidelines but I'm not sure that it is the latest version

onlinelibrary.wiley.com/doi...

(it was revised slightly recently to improve the treatment protocol for B12 deficiency without neurological involvement)

Main points to make:

a) serum B12 test is not 100% accurate and gives result that vary by 20%

b) evaluation needs to take into account symptoms - particularly if there are neurological symptoms

c) 25% of patients with B12 deficiency don't have any signs of macrocytosis

d) The test indicates what is happening in blood, not what is happening in cells.

Whilst not actually in the guidelines your GP also needs to be aware that normal range is statistically determined. it is a huge range. Individuals tend to regulate B12 levels in at a level that is specific to them and could be anywhere in the range (and in a few cases outside the range). However, the mechanism that allows this depends on the same mechanism that goes wrong in absorption problems so will lead to levels falling. Using a single measure to try and diagnose a B12 absorption problem can therefore be problematic.

Test for homocysteine and MMA can help to clarify if looking at a single point in time. Homocysteine will also be affected by low folate so would be inconclusive in this case. MMA may require referal to a hospital/haemotology department.

e) folate absorption problems would be on the + side in evaluating a B12 deficiency.

[lucylocks]

Many thanks for your reply, and detailed information and the link.

I will print it off and give it to my son in law and tell him to make another appointment with his G.P.

I really do think he needs the injections especially as both his parents have them and are greatly improved with them.

Thank you again.