Can anyone help me interpret / argue my blood results to my GP?

[tea_leaf]

Hi, I had a full run of bloods last week which have all been signed off as "satisfactory" by the GP. This doesn't solve anything, as I'm still so exhausted that I sleep through 3 alarms including a sunlight alarm clock every morning and can barely keep my eyes open all day.

I'd be really grateful if anyone has any information or an opinion that could help me when I speak to the GP next week on what I should be asking to happen next, as I strongly believe there is more to this than meets the eye. I gather that one of my meds (topiramate) is linked to vitamin B12 deficiency, but my B12 levels are bang in the middle of the levels.....

Relevant info if it assists anyone:

I take topiramate 200mg and sertraline 100mg every night for anxiety / depression and migraine prevention. I have pins and needles in my fingers, toes and feet at random times of day and night, usually when I'm sitting down though. I eat well - plenty of fruit, veg and meat including red meat. I have a dog so we both get plenty of exercise and outdoors access to daylight (such as it is at this time of year).

Blood results:

Serum iron level 14 umol [9.0-30.0 range]

Serum vitamin B12 level 393ng/L [187.0-883.0]

Serum ferritin level 105ug/L [10.0-204.0] "Normal ferritin levels do not rul out iron deficiency" (comment on the test results from lab)

Serum TSH level 0.92miu/L [0.35-4.94]

Serum folate lvel 3.6ug/L [3.1-20.0]

Plasma C-Reactive Protein level 1mg/L [0.1-5.0]

Urea and electrolytes:

Serum sodium level 139 mmol/L [133.0-146.0]

Serum potassium level 4.9 mmol/L [3.5-5.3]

Serum creatinine level 78 umol/: [50.0-98.0]

eGFR using creatinine (CKD-EPI) per 1.73m2 83 ml/min/1.73m^2

Serum transferrin level 2.71g/L [1.8-3.82]

Transferrin saturation 20.56% [16.0-45%]

Haemoglobin A1c level - IFCC standardised 32 mmol/mol

FBC:

Total WBC count 6.1 10*9 [3.9-92.]

Haemoglobin concentration 144g [120.0-155.0]

RBC count 4.6 10*12 [3.9-5.1]

Haematocrit 0.422l/l [0.37-0.46]

Mean cell volume 92.0fl [80.0-105.0]

Platelet count - observation 313 10*9 [140.0-400.0]

Neutrophil count - 3.8 10*9/l [1.7-6.2]

Lymphocyte count - 1.6 10*9/l [1.0-3.4]

Monocyte count - observation 0.41 10*9/l [0.2-0.8]

Eosinophil count - observation 0.34 10*9/l [<0.4]

Basophil count 0.00 10*9/l <0.1]

Nucleated RBC's 0.00 10*9/l

Liver function tests - all normal (can specifiy if anyone thinks they are relevant)

Bone profile - all normal (can specifiy)

[mightydrunken]

I am not a doctor so I am not the best person to analyse your results...

Your B12 looks good, have you taken any B12 supplements which could increase your reading? Your folate looks a little low, but still in range. Folate deficiency has similar symptoms to B12 deficiency.

Your pins and needles could be due to peripheral neuropathy which can be caused by B12 or folate deficiency but also other ailments like diabetes. You could try taking 1000 micrograms of B12 and 800 mcg of folate per day over a few weeks and see if your symptoms improve. If not then see your doctor again and see what else it could be.

Topiramate use has been associated with lower B12 blood levels, yet your results appear to be OK. Interestingly I found one case where topiramate was suspected of causing peripheral neuropathy but generally it is thought to protect against it! One (probably far out) possibility is that topiramate is actually repairing your nerves from previous peripheral neuropathy and the pins and needles is the result of that.

grantome.com/grant/NIH/U01-...

[tea_leaf in reply to mightydrunken]

Very interesting perspective, thank you - great food for thought. The peripheral neuropathy was claimed to be a common side effect of the Topiramate....

I'm taking no supplements at all, but intend to now take appropriate multi vitamins / iron / calcium etc to make sure I'm topped up.

I've looked at a little more info on Topiramate today and am beginning to think it could all be linked to that - others on migraine forums describe similar symptoms after a year or so on it and have had to come off it and had complete resolution of their issues. I need a GP that will take me seriously!

[Nanc72 in reply to tea_leaf]

Topirimate will 💯 give you those side effects, as well as: Foggy memory, change the way your food tastes, decline your food intake (they also use it in weight loss) I took it for migraines and it, did all those things to me.