low b12 level

[ShaneWarne]

Hello everyone,

I was recently tested for b12 and the level is 203 ng/L [220.0 - 700.0].

How low is it, should I start taking vitamin b12 tablets OR injection?

[wedgewood]

Yes your B12 is on the low side . What you don’t mention is if you have any symptoms of B12 deficiency . If you do, you need to find the cause . B12 is only found in animal products . So it could be your diet and ( strict vegetarian or vegan . You can find out the all the reasons for b12 deficiency by reading through the “pinned posts “ you find on this forum .

For B12 to do it’s work , vitamin B9 ( called folate in fruit and veg and folic acid in tablet form ) is necessary. So do you have a reading for that ? It’s important .

So in the first instance , get back to us about all that , and you can be advised further . Best wishes .

[ShaneWarne in reply to wedgewood]

Thank you for your reply. My symptoms is fast heart rate (palpitation) only after eating a meal, loose stool, dizziness, vertigo (only sometimes when I stand up quickly), chest pain.

I had 3 ecgs which are all clear, nothing in blood test as well.

I am not vegetarian and eat a lot of chicken but not the red meat.

I haven't been tested for vitamin b9 yet. My H Pylori test came back positive but I don't have any H pylori symptoms.

[Shashapoo in reply to ShaneWarne]

Was your magnesium level checked?

[ShaneWarne in reply to Shashapoo]

Yes magnesium level was fine too

[wedgewood in reply to ShaneWarne]

With those symptoms , and your B12 at a low level , your doctor should be giving you loading doses of B12 ( 6 injections over 2 weeks . The injections should be continued until any symptoms still remaining fail to improve . Your B9 , ( folate/ folic acid ) should also be tested/ supplemented . Your doctor may also test you for P.A. with the Intrinsic Factor Antibody test.. This test, if negative , is very unreliable, but never-the -less, with your symptoms and low B12 , you should get treatment.

Please keep us informed of how things progress.

[Gambit62 Administrator in reply to ShaneWarne]

the vertigo sounds like postural hypotension if it is affecting you when you stand up.

I would suggest talking to your doctor again. See if you had an earlier B12 test that came back with a much higher level. The chances are that you are B12 deficient and have a B12 absorption problem with a level that low but diagnosing B12 deficiency just on the basis of serum B12 is prone to errors.

Its also worth having a look at the actual symptoms of B12 deficiency. They are many and varied and because of the way the body processes B12 they generally come on very slowly over time - years or even decades - so they don't spring to mind when you are asked about your symptoms

pernicious-anaemia-society....

H pylori will cause B12 absorption problems and you will need a course of antibiotics - and probably to be put on PPIs which will also interfere with B12 absorption.

Given the symptoms you have listed so far I would be a bit more cautious that wedgewood about jumping to treatment. A few people will be okay at B12 levels below the normal range because the normal range is a statistical average that reflects where most people are okay. Also, the serum B12 test is only accurate to 20% so your actual results could be just in the normal range. Although B12 isn't toxic raising B12 levels with B12 injections can fundamentally change the way your body processes B12 and could cause problems. You also don't list anything that leaps out to me as a neurological symptom and I assume your blood work didn't show any type of anaemia - but if, when you look at the list of symptoms, you realise that you do have neurological problems then that would move me towards starting treatment without delay.

There are a few tests you could ask for that look at products that build up if your cells don't currently have enough B12 - namely homocysteine and MMA - so it may be worth getting those done as well - homocysteine is also affected by low folate and MMA by kidney issues so the tests need to be done in conjunction with other tests to get the correct interpretation. MMA may only be available through a hospital appointment.

[JMN2017]

ShaneWarne

On reading your symptoms above, I wonder if you might actually be anaemic. I would assume your GP has also tested for the usual stuff, including anaemia? I can't believe a GP would overlook such though

Just a thought ...

[ShaneWarne in reply to JMN2017]

Thank you for your reply. My GP also requested a full blood count and here are the results:

Total white blood count 8.8 x10^9/L [4.0 - 11.0]

Red blood cell count 4.66 x10^12/L [4.5 - 6.5]

Haemoglobin concentration 142 g/L [130.0 - 180.0]

Haematocrit 0.416 L/L [0.4 - 0.54]

Mean cell volume 89 fL [80.0 - 99.0]

Mean cell haemoglobin level 30.4 pg [27.0 - 32.0]

Platelet count - observation 402 x10^9/L [140.0 - 400.0]

Outside reference range

Neutrophil count 7.39 x10^9/L [1.5 - 7.5]

Monocyte count - observation 0.30 x10^9/L [0.2 - 0.8]

Eosinophil count - observation 0.01 x10^9/L [0.04 - 0.4]

Outside reference range

Basophil count 0.02 x10^9/L [0.02 - 0.1]

Lymphocyte count 1.11 x10^9/L [1.0 - 4.0]

Nucleated red blood cell count < 0.20 x10^9/L [0.0 - 0.2]

I don't think I am anaemic.

[JMN2017 in reply to ShaneWarne]

Totally agree ShaneWarne