MCV increasing / folate levels

[Vicky2822]

Just a quick question. When my daughter was first diagnosed with vit b deficiency her MCV was 92.5. She has been on every other day injections for a few months but it has risen to 94.8 - should it not have decreased ?

Her ferritin was also low so is it just that low iron was masking the result to start with (been on ferrous sulphate tablets for few mths).

Can I also ask about folate. It was 4 when she was first diagnosed so started on 5mg folate, just had blood test b12>1500 ug/l and folate > 25ng/l. She is still on every other day b12 injections so do I stop the folate for a while or put her on a much lower daily dose?

Thanks

[JanD236]

Have you had your daughters ferritin re-tested?

I would think that if folate is above range you don’t need to supplement at the very high level you’re doing at the moment. I’d hope that a good diet and daily multi vitamin would suffice.

I have a similar question about MCV/MCH but rather than jump in on your post I’ll post it separately.

[Vicky2822 in reply to JanD236]

Ferritin had gone up to 33 in Jan (orig 14 in Nov) meant to have it redone last month but nurse said it was fine and wouldn’t do it.

[noszbe]

If you are using "folic acid" rather than "methylfolate", then that could be messing with how the B12 works. In some people, it makes a big difference, e.g. pnas.org/content/106/36/154... and probably explains the much higher rates of certain cancers associated with folic acid, and lower rates with methylfolate e.g. ncbi.nlm.nih.gov/pmc/articl... . The high level of folate may be masking high unmetabolized folic acid (UMFA), e.g. ncbi.nlm.nih.gov/pmc/articl... sci-hub.tw/10.1007/s10815-0... etc

[FlipperTD]

Hi. This can be a bit confusing. (I am a scientist, not medic, so I can't offer advice.)

When a deficiency state is being corrected, then the MCV may appear to rise a little, anomalously, depending on the timing of the samples and the degree of anaemia needing correction. (Every case is different; there are no hard and fast rules.)

This is usually due to the fact that the reticulocytes (the new red cells) are actually larger than mature cells. This effect disappears as the deficiency is treated. The RDW (red cell distribution width) increases at this time, and then it returns to normal once the different-sized cells have been replaced. It typically reaches a maximum half way through treatment.

I hope this helps.