Low Haemoglobin

[foxglove]

I have recently had FBC done and hb was 107 (lab. range 115.65-165) I have to have following tests done :- B12& Folate, Folate and Ferritin Does anyone know why B12& Folate has to be done as well as Folate? IsB12 not usually done separately? Thanks

[FlipperTD]

I worked in a laboratory for very many years, and ran the service which performed Serum B12 & Folate assays, amongst other things.

Simple answer to your question is that it was simpler to perform the tests simultaneously than as two separate requests, as they were done on automated platforms that did both at the same time. This was done usually to investigate a macrocytic anaemia. It's not possible to differentiate between the potential causes of macrocytosis without measuring both. In addition, when someone has been treated for B12 deficiency, it's important to keep an eye on the folate level too. I accept that when you are being treated for B12 deficiency then testing for B12 does not add value, unless there are compliance issues such as 'not taking the tablets' or 'not getting the injections'. I admit this isn't entirely satisfactory, but it is certainly the way things were, and probably still are.

[foxglove in reply to FlipperTD]

Thank you for your detailed reply - very kind of you to take the trouble. I wonder if you would be even more patient to tell me what macrocytic anaemia is? I am 80 now and although have experienced anaemia on a few occasions it was just treated with a short course of iron tablets, Last time my B12 tested was just over 2 years ago, result 604 which doc. accepted . I was not taking supplement Shouldn't be doing this but giving into temptation to Google macrocytic anaemia now!!!

[FlipperTD in reply to foxglove]

Hi.

Macro=Large, Cyte=Cell, so large cells, in this case, large red cells. The opposite is Microcytosis. Microcytic anaemia is usually iron deficiency , but not always. Macrocytic pictures are generally either due to B12 or folate deficiency [or both] but can also be found in other conditions. Excess alcohol consumption can be reflected in a macrocyctic picture. The indicator for macrocytosis is the MCV, the 'Mean Cell Volume'. The 'Mean Cell Haemoglobin', [MCH] tells much the same thing, as the one tends to reflect the other. Nowadays, the RDW [Red Cell Distribution Width] gives more information because it reflects the range from small to large red cells. When everything's stable, then the RDW tends to a minimum value, but if B12, folate or iron start running out, then the MCV changes and the RDW increases, because there are two populations of red cells; normal, and large [B12 or folate deficiency] or small [iron deficiency].

I hope this isn't too confusing.

[foxglove in reply to FlipperTD]

Thanks again for the detail! Confusing ? -just a bit

Recent bloods results:-

MCV - 89 (lab range 80.00-100.00fL) MCH :- 27.1 ( Lab. Range -27.00 -33.00pg) RDW:-15.3 (Lab Range -11.00-14.800% )

None of this looked drastic to me But..... Hope I'm not confusing you now. Had phone call with dr and he said reason latest tests requested was that my hb had dropped from last test 107,from 111.50.lab range 115.00-400.00

[FlipperTD in reply to foxglove]

Hi. You're not confusing me at all. Looking at your results, I can deduce things you haven't quoted. Your MHCH is a bit on the low side; about 30.5 [although if they're reporting in g/Litre, it'll be 305]. I get the 305 number from (MCH/MCV). The RDW is raised, suggesting something's changing. If you've not had your iron checked, it would be worthwhile because the falling Hb and borderline MCH could be explained by iron deficiency waiting just around the corner.

I hope this helps.

[foxglove in reply to FlipperTD]

Thanks once more, bloods to be checked next Thurs. G.P. who phoned said I WAS anaemic (have had FBC done which suggests anaemia, follow up Thurs. (I think) is to confirm this) I have been very tired for some time so perhaps iron deficiency is the reason... who knows, I seem to spend more time at doctors these days than I ever have in my entire life

[FlipperTD in reply to foxglove]

Good luck. I'm sure your GP will be helpful.