The National Institute for Health and Care Excellence (NICE) has a page with "do not do recommendations". They recommend that b12 should not be tested unless a full blood count shows macrocytosis. Haven't they heard about the concern that folate and folate fortification may mask a b12 deficiency in the sense that enough folate may prevent macrocytic anemia so that macrocytosis is no longer a good indicator of a potential b12 deficiency?
Here's a link to the NICE Do Not Do Recommendation for b12 2020. It includes links to other do not do recommendations.
Thanks for that info . That is shocking . What to do in the face of such medical ignorance from an NHS body which should know better ? It leaves me utterly speechless ! I wonder if our Chairman , Martyn Hooper , knows about this ? I thought that it was a medical fact that patients could have P.A. without having macrocytosis . Must get hold of N.I.C.E. What a name to have !
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They are also from 2007 - before the BCSH guidelines were updated to recognise the limitations of serum B12 testing.
Unfortunately the processes for updating guidance on NICE is disjointed, so I'm not surprised that a reference to guidance/guidelines on another disorder hasn't been updated for changes in relation to B12 disorders.
This exact thing happened to my brother. Very low b12 but doctor just gave him folic acid which just made the damage continue. Mixed in with M.S. (Multiple Sclerosis )I don't think anyone knows what is actually going on. It's disgusting.
Just read the article and as far as I can see it is stopping supplements which could help unless people pay for them theirselves. Just another money saving scam. Same with blood tests.
In Martyn Hooper's latest book( "What You Need to Know About Pernicious Anaemia & Vitamin B12 Deficiency") he says that macrocytosis (enlarged red blood cells) occurs only in around 60% of cases.
He then provides 4 quotes from relevant research, one of which likens the requirement for megaloblastic changes to be present for a PA diagnosis to only diagnosing liver disease if jaundice is present !
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