Guidelines re treatment with normal B12 levels

[Howzer]

Family history of pernicious anaemia. I’ve had various symptoms for a long time. Bloods are normal. GP won’t treat for B12 deficiency despite being symptomatic. Referral to mental health team 🙄 Can’t find guidelines regarding treatment. Would anyone be kind enough to point me in the right direction? Based in Scotland

Thanks in anticipation

[fbirder]

There are no real national guidelines. The British Committee on Standards in Haematology say - onlinelibrary.wiley.com/doi...

1 The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status because there is no ‘gold standard’ test to define deficiency.

...

4 In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment.

[Howzer in reply to fbirder]

Thank you

[Sleepybunny]

Hi,

Here are a few useful links.

BMJ B12 article

bmj.com/content/349/bmj.g5226

Emphasises need to treat patients who are symptomatic even if their B12 level is within range.

BSH Cobalamin and Folate Guidelines

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

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...

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

See points 1 and 5 in above link.

With a family history of PA, worth joining and talking to PAS.

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...

I wrote a very detailed reply on the thread in next link with links to UK B12 documents, B12 books, b12 websites and lots of other b12 info.

healthunlocked.com/pasoc/po...

You might be interested in this link to a petition about b12 deficiency that went before Scottish Parliament.

parliament.scot/GettingInvo...

There is a PAS (Pernicious Anaemia Society) support group in South Scotland.

pernicious-anaemia-society....

I am not medically trained.

[Sleepybunny]

Hi,

Have a look at this flowchart from BSH guidelines and politely stick it under your GP's nose or refer to it in letter to GP.

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

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

[gingerbear644]

It's time to switch these quack doctors. I've switched until I found one