Advice on levels

[Lorstor]

Hi guys! Talked to my daughters primary doctor and she agreed to do weekly B12 injections for her pernicious anemia: again we are in the USA. Primary doctor and I discussed doing bloodwork to get update. This bloodwork was drawn 5 days after an injection.

Folic acid 9.7 ng/ml. >3.0 ng/ml normal

B-12 592pg/ml. 200-950

Homocysteine 10.2 Mcmol/L. 5.0-15.0

Methylmalonic Acid. 125 nmol/L. 0-378

Again, does it seem odd that her B12 is only 592 right after a B12 injection. In Feb. she got a week of loading doses again (her levels were in the 300’s with monthly injections) and then did weekly for a month and then went to monthly. Also, I would assume all her other levels are normal but do you all read anything into them?

Thanks for any input you can offer, and keep in mind she has autism so cannot easily tell me how she is feeling. Thanks. Lorstor

[Gambit62 Administrator]

After an injection levels will be off the scale and then will fall over time - mainly because kidneys remove excess B12.

I presume your daughter is receiving cyanocobalamin. Whilst the average 'retention' is one month people vary a lot in how quickly kidneys remove excess so your daughter would appear to be at the quick end of the scale.

Managing levels post shots on basis of serum B12 doesn't really work and you do need to go by symptoms.

The MMA and homocysteine levels show that, at the time of the test, your daughter had enough B12 in her cells to run the two processes that recycle these.

[Nackapan]

From what I have learnt I agree the levels are lower than you would expect but high enough. As you now are getting more injections for your daughter the levels should raise and stay there. Some forms of b12 suit people better than others. There are more well informed on this forum than I to comment on that. When my folate was 9 I took folic acid but then it went above range! So if she has supplements good to get bloods done 3 monthly. Ferritin and vit D good to keep an eye on too. Hope your daughter gets the benefits from increasing b12 Im injections very soon.