Should my sister take b12 pills?

[Sick-and-Tired]

Hello!

My sister has been quite unwell for a number of years, she had some tests done a couple of years ago by her GP which included Serum B12 and came out below range at 160 (lower limit was 200).

The GP told her to take b12 pills which she did, and she went back for another test which the doctor told her was within range (not sure how much it had gone up by).

I've been on at her to go back to the doctor and get it looked at again but getting appointments at her practice is very stressful so in the end I convinced her to do a medichecks test.

Everything's in range, but I wondered whether anything jumped out at you? To me her folate and ferritin look like they could do with a boost. As well as her B12. Do you think at these levels they could just be fixed with a good b-complex? The report that medichecks sent said to just take some b12 supplements. And could she be having symptoms with these levels?

(As some context, I have hashimotos and our brother has lichen sclerosus so there's definitely autoimmune problems in the family, but she's had her thyroid checked and it all looked fine, and no antibodies at all)

Haemoglobin - 151 g/L (120-160)

Haematocrit - 0.456 L/L (0.35 - 0.47)

Red blood cell count - 5.18 (3.8-5.8)

MCV - 88 fl (81-98)

MCH - 29.1 Pg (27-33)

MCHC - 330 g/L (300 - 350)

RDW - 13.7% (11.5-14.4)

White blood cell count - 7.91 (3-10)

Neutrophils - 4.03 (2-7.5)

Lymphocytes - 3 (1.2-3.65)

Monocytes - 0.64 (0.2 - 1)

Eosinophils - 0.11 (0-0.4)

Basophils - 0.09 (0-0.1)

Platelet count - 336 (150-400)

MPV - 10.5 fl (7 -13)

Ferritin - 33.6 ug/L (13 - 150)

Folate (serum) - 7.92 ug/L (>3.89)

Vitamin B12 (active) - 45.2pmol/L (37.5 -188)

Any thoughts would be really appreciated!

Thanks!

[Gambit62 Administrator]

I think you need to ask your sister to get the results of the second serum B12 test.

Serum B12 is only accurate to about 20%. so if the second test had showed a rise but is within that range then the result is inconclusive. If the rise was more than that it would imply that she doesn't have an absorption problem (with a small caveat around very high dose tablets, which could have raised B12 even in the presence of an absorption problem, but won't raise it very quickly).

It would also be useful to know the strength of the tablets she was given, whether or not she is vegan/vegetarian and if the tablets actually made any difference to her symptoms.

If they made no difference to her symptoms whatsoever then unlikely that continuing to use them would have any effect. If they helped then continue taking them.

This forum isn't a substitute for proper professional medical advice, though I recognise that getting knowledgeable medical advice when it comes to B12 can be very difficult.

There is nothing in the results above that screams either microcytic (iron based) or macrocytic (B12/folate based) anaemia. Ferritin is a protein that binds to iron and is only one measure of iron status - the other measures in the results above don't indicate a problem with iron levels ... and there have been cases where people have been guided by ferritin on its own and the result has been a patient with iron toxicity.

Active B12 is a more accurate test but still no guarantee that the level shown is actually the one that is right for your sister.

Sorry, but there really isn't anything obvious in the above.

[Sick-and-Tired in reply to Gambit62]

Thank you so much for your response - I didn't get a notification so didn't realise you had replied!

That's great - as long as you don't think I should suggest she do an MMA or homocysteine test with those levels then I'll just tell her to get back on the pills!

I really appreciate your response, thanks again so much!

[Gambit62 Administrator in reply to Sick-and-Tired]

if she feels better with the tablets then I wouldn't bother with MMA and hoocysteine.

[Sick-and-Tired in reply to Gambit62]

Thanks. She hasn't felt any better with the tablets so far but obviously not sure whether it's b12 causing it or something else completely. It just seemed so low on her first tests I thought it might be that, although she's feeling worse than ever at the moment she her B12 has gone up!

Thanks again for your help!