Enlarged red blood cells

[Andypandy30]

If this is signicant on blood tests along with symptoms but normal level of b12 is the next stage not correct to be treated by b12 injections ? Another family member who has been referred to a&e by gp instead of being treated .

[Gambit62 Administrator]

There are a number of things that can cause large red blood cells. B12 deficiency and folate deficiency are just the most common

[Andypandy30 in reply to Gambit62]

Thank you Gambit I know this also . She has hypothyroidism as well but that has been causing no other issues . What should he be doing next then if b12 levels are normal

[Gambit62 Administrator in reply to Andypandy30]

encourage GP to follow BCSH standards and evaluate on the basis of symptoms as the guidelines are clear that B12 deficiency can't be ruled out if results are in range - particularly if they are low in range. Ruling out other possibilities would be part of this and should be pretty easy and is probably all there from the blood tests that have already been done. If they have neurological symptoms then make sure the GP is aware of the recommendations for immediate action.

onlinelibrary.wiley.com/doi...

[Sleepybunny]

Hi,

Your relative might want to read BMJ article below. It emphasises need to treat patients who are symptomatic for B12 deficiency even if B12 levels are within normal range.

BMJ B12 article

bmj.com/content/349/bmj.g5226

Other UK B12 documents

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

Flowchart outlines process for diagnosing PA and Antibody Negative PA in UK

BNF

bnf.nice.org.uk/drug/hydrox...

BNF guidance on treating b12 deficiency changed recently.

pernicious-anaemia-society....

NICE CKS

cks.nice.org.uk/anaemia-b12...

From personal experience, I had many typical symptoms of B12 deficiency with b12 results mainly within normal range. Most of my B12 results were 300 - 500 ng/L.

Perhaps your relative may be able to persuade doctors to test MMA, Homocysteine and Active B12 (holotranscobalamin)?

Link about "What to do next" if B12 deficiency suspected

b12deficiency.info/what-to-...

Blood tests

b12deficiency.info/b12-test...

Macrocytosis

patient.info/doctor/macrocy...

Full Blood Count and Blood Film

labtestsonline.org.uk/tests...

patient.info/doctor/periphe...

Folate Deficiency

patient.info/doctor/folate-...

Have her folate levels been checked?

Folate deficiency can lead to macrocytosis (enlarged red blood cells). Important to treat any co-existing B12 deficiency if folate treatment is given. See Management section in above link.

Iron Studies

labtestsonline.org.uk/tests...

What symptoms does your relative have? Do they have any neurological symptoms?

Symptoms of B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/signs-an...

Risk Factors for PA and B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

More B12 info and links

B12 books I found useful

"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper

Martyn Hooper is the chair of PAS (Pernicious Anaemia Society). Book does not show updated BNF info.

"Living with Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Has several case studies.

"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)

Very comprehensive with lots of case studies. There is also a paediatric version of this book "Could It Be B12? Paediatric Edition: What Every Parent Needs to Know".

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

PAS tel no [phone] answerphone

PAS support groups in UK

pernicious-anaemia-society....

Blog post about how PAS can support PAS members seeking PA diagnosis

martynhooper.com/2017/06/24...

PA tests

Intrinsic Factor Antibody (IFA) test

labtestsonline.org/tests/in...

Parietal Cell Antibody (PCA) test

labtestsonline.org/tests/pa...

PCA is not recommended as a diagnostic test for PA in UK.

Both these tests can be unreliable.

It is still possible to have PA with a negative result in IFA or PCA test.

About 50% of people with PA test negative on IFA test.

About 10% of people with PA test negative on PCA test.

B12 Deficiency Info website

b12deficiency.info/

B12 Awareness (US website)

b12awareness.org/

B12d.org holds support meetings near Durham, UK

b12d.org/event

Stichting B12 Tekort (Dutch website with English articles)

stichtingb12tekort.nl/weten...

UK B12 Blogs

Martyn Hooper's blog about PA

martynhooper.com/

B12 Deficiency Info blog

b12deficiency.info/blog/

Coeliac Disease

NICE guidelines Coeliac Disease (2015 version) suggest anyone with unexplained B12, folate or iron deficiency should be tested for Coeliac. Check both recommended tests are done as UK doctors sometimes forget to do second one.

1) tTG IgA test

2) Total IgA test

nice.org.uk/guidance/ng20/c...

H Pylori infection

patient.info/digestive-heal...

Nitrous Oxide

gov.uk/drug-safety-update/n...

Neurological Consequences of B12 Deficiency

PAS news item

pernicious-anaemia-society....

PAS article about SACD, sub acute combined degeneration of the spinal cord, access to PAS members only.

pernicious-anaemia-society.... See Page 2 of articles.

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

Point 1 in above link is about under treatment of B12 deficiency with neuro symptoms.

Point 5 is about being symptomatic for B12 deficiency with an in range B12 result.

CAB NHS Complaints

citizensadvice.org.uk/healt...

HDA patient care trust

UK charity that offers free second opinions on medical diagnoses and medical treatment.

hdapatientcaretrust.com/

I am not medically trained.