Ongoing issues

[Laurencardell]

Hi all. I have recently joined.

I was diagnosed with B12 deficiency in 2017 and I receive regular B12 injections for this every 3 months. I also take folic acid 5mg and I have been taking this since 2016 when a deficiency in this was found. I also have consistently below range MCV with a normal range ferritin and everything else for complete blood count has been fine and in range.

However I have ongoing issues that are really concerning me and I have made a list of them below:

Dry lips that get sores on them

Dark circles under eyes

Cold and discoloured toes

Splitting nails

Dry skin especially on hands, legs and feet

Fatigue

Breathlessness

Heavy and painful periods

Losing hair

Thinning hair

Feeling cold

Loss of appetite

Thanks for reading and for any light shed on below results for B12/folate.

Feb-2019

Vitamin B12 1443 pg/L (190 - 900)

Folate 2.35 ug/L (2.50 - 19.50)

[fbirder]

Wow! You're taking 5000 mcg of folic acid a day and you're still deficient! What is your doctor's explanation for that?

A low MCV suggests iron deficiency. Or, maybe, thalassaemia. I presume you've been checked out for both. Iron deficiency could be caused by heavy periods. Are you on any iron supplements?

[Laurencardell in reply to fbirder]

Hi and thank you fbirder for your response.

There is no explanation from my doctor at all as to the folate deficiency. She has said unless my diet is low in folate there is no reason for my folate to drop so much. I asked her why, despite me taking folic acid, it's still deficient or if any further investigations into my symptoms are needed and she answered "none of your levels warrant further investigation and you don't need anything to be reviewed" whilst smiling at me.

I'm not sure what thalassaemia is, I had iron deficiency corrected back in 2018 with an iron given to me via a drip but the below range MCV still persists. The MCV going below range seems to happen a few days after my period ends so yes I am guessing heavy periods are causing it. Because my ferritin is high in range I have had my iron prescription removed.

[clivealive Forum Support in reply to fbirder]

Would an MMA test be useful here fbirder ?

[fbirder in reply to clivealive]

No, an MMA test wouldn't be much use. Homocysteine test would show that there was a good possibility of a folate deficiency at the cellular level.

[Laurencardell]

So I've looked at thalassaemia and I am not sure I have this - my haemoglobin was mid range and I'm not of Mediterranean, Chinese, African American or Asian descent. There is no genetic history of thalassaemia either, just diabetes, multiple sclerosis, poly cystic ovarian syndrome, Cushing's, hypothyroidism and high cholesterol.

Feb-2019

Ferritin 110.3 ug/L (15 - 150)

MCV 81.2 fL (83 - 98)

MCHC 358 (310 - 350)

MCH 28.1 (28 - 32)

Haemoglobin 135 (110 - 150)

Red blood cell count 4.41 (3.80 - 5.80)

White blood cell count 7.13 (4.00 - 11.00)

Platelets 410 (140 - 700)

Neutrophils 0.2 (0.0 - 0.8)

Basophils 0.0 (0.0 - 0.5)

Eosinophils 0.2 (0.0 - 1.0)

Monocytes 0.5 (0.0 - 0.8)

Lymphocytes 1.4 (0.0 - 2.0)

[Gambit62 Administrator in reply to Laurencardell]

your red blood cells appear to be smaller than normal but also rounder (raised MCHC) than normal. That could be a mix of iron deficiency (smaller) and folate deficiency (rounder). You probably need a referral to a haematologist.

Most folate is absorbed in the ileum - so if there is a gastric condition affecting the ileum (and causing B12 absorption) there may also be having an impact on folate absorption - an endoscopy is probably going to be the only way of confirming that. If you have low stomach acidity that can affect absorption of vitamins and minerals - including iron which could also explain why iron continues to be a problem. Again, referral to a gastro might help with clarifying

[Laurencardell in reply to Gambit62]

Ok thank you Gambit62. I am no longer under haematology unfortunately, but they do suspect I might have coeliac which might account for the folate deficiency.

[Laurencardell in reply to Gambit62]

I had an endoscopy done in 2016, that showed acid reflux.