low hemoglobin and red blood counts

[ENG76]

Came across this forum as I was looking for some answers to a variety of symptoms I have been experiencing for some time. I have had below normal red blood counts for as long as I can remember. My hemoglobin is at the bottom of the normal range or a little below normal. My question is, can I have "low normal" hemoglobin and red blood counts and still have pernicious anaemia? My doctor wants we to try some antidepressant meds before I so a B-12 test as he feels my symptoms are are being caused by depression.

[Nackapan]

Have your b12 folate vitamin d ferritin as well as thyroid and fbc.

Do you think you need antidepressants?

I've been offered them about 11 times or more . In my opinion given out too quickly before other reasons explored.

Yes you can have low normal blood count and have Pernicious anaemia you csn have PA without it too. You can be b12 deficient and not have PA

PA in an autoimmune disorder.

The test used is the intrinsic antybody blood test. If positive you have pA if negative there is still a possibility you have it.

Usually done if b12 low.

You havent mentioned what your symptoms are ?

Get bloods done first in my opinion then make a decision about antidepressants and any other meds?

[ENG76 in reply to Nackapan]

Not sure about the antidepressants. I have resisted for a long time but am starting to wonder if they may help. These are my symptoms: fatigue/ low energy levels, shortness of breath, back tingling/pain, rib pain, foggy brain function at times, depression, tingling in my wrist and ankle areas at times (comes and goes) gastrointestinal issues, these also come and go. I know these can be caused by a lot of things, looking for answers. Thanks.

[Nackapan in reply to ENG76]

Also hyplori test. As mentioned on previous post. Some have had rib pain.

Get all the tests you can.

Sometimes a case if elimination.

That's the trouble lots of symptoms overlap with different causes

I hope you get some answers to make informed choices of treatment.

[ENG76 in reply to Nackapan]

Thank you, I appreciate your feed back.

[fbirder]

There is nothing to stop you having low haemaglobin and PA. However, PA will not cause low haemaglobin.

What are your exact results for B12, folate, haemaglobin, MCV, ferritin, etc.

Why do you think you may have PA?

[ENG76 in reply to fbirder]

I guess I was under the assumption that b12 not being absorbed would cause low hemoglobin. With all of my symptoms they seemed to align with this disorder. As I mentioned, my doctor wants me to try antidepressants before he does any blood work...

[Gambit62 Administrator in reply to ENG76]

low B12 doesn't affect the absorption of iron but a condition that affects the absorption of B12, leading to a B12 deficiency, may also affect the absorption of other micro-nutrients, most commonly folate and iron.

[ENG76 in reply to Gambit62]

I see, thanks for the explanation. As I said, I am trying to get to the bottom of my symptoms and many of them can be explained with low B12. I also suffer from tinnitus which I failed to mention earlier with my other symptoms.

[Gambit62 Administrator in reply to ENG76]

unfortunately there is a huge overlap between the symptoms of B12 conditions and many other conditions - sometimes it is easier to rule out other conditions than confirm B12 deficiency.

[ENG76 in reply to Gambit62]

Won't a B12 blood test confirm low levels of B12? I know it won't give you the reason if your levels are low, that would require other testing I'm guessing.

[Gambit62 Administrator in reply to ENG76]

serum B12 is difficult to interpret - the range where most people naturally sit is extremely large so there are considerable logical problems with assuming that a given individual is okay at a given point - all you have is the probabilities.

Other tests can have similar problems - eg using T4 to check on thyroid function.

All a serum B12 test tells you is the amount in your blood - it doesn't tell you how efficiently that B12 is getting from your blood to your cells, or how efficiently it is being used in the myriad of processes that use B12 in your cells.

[ENG76 in reply to Gambit62]

So when you get an injection of B12 and you have PA how it absorbed? I guess I'm confused, I was thinking if B12 levels in you blood were normal, it was being used. I thought the problem was getting the B12 into your bloodstream to be used??

[Gambit62 Administrator in reply to ENG76]

PA is a problem with absorbing B12 in the gut.

The 'problem' with an injection is that it introduces an unnatural condition - extremely high serum B12 levels. This can fundamentally change the way mechanisms that transfer B12 from blood to cells operates (though why isn't know) - and can make the process much less efficient - meaning that some patients who have had injections need to maintain much hgher levels of B12 (often well above the accurately measurable range and certainly above the normal range) for enough B12 to get through to cells.

Serum B12 levels will gradually fall over time but the time taken can vary a great deal - studies years ago showed that some patients actually took years for the B12 levels to fall, though on average it took 1 month with cyanocobalamin injections and 2 months with hydroxocobalamin injections

[Slothlike]

I have consistently low haemoglobin/red blood cells slightly below reference range (typically 0.38 haematocrit) and a range of symptoms (fatigue, confusion/poor memory, IBS, muscle weakness etc etc) . I initially approached the GP after hand and sock numbness ( I couldn’t turn pages of a book or feel anything in my toes) . After around 30 tests I was diagnosed with ME and started taking B12 and Folate after advice that “it helps some people with ME”. This had a dramatic effect on brain fog and some other symptoms. However I was never convinced this was PA (despite this being in my family and my b12 being lowish) mainly because oral b12 and folate seemed to improve symptoms (particularly folate). I was not ‘iron anaemic’ since my ferritin was normal.

Anyway fast forward 8 years I’ve now been tested and found to have chronic lead poisoning (we recently have completed some house renovations and replaced lead water pipes).

Reading up on this it appears that haemolytic anaemia (abnormally high destruction of red blood cells) can have a variety of causes (heavy metal poisoning being one of them). My slight improvements with b12 and folate is likely to be from correcting a slight deficiency (Possibly driven by the haemolytic anaemia?) rather than fixing the underlying problem.

In my case there is little that can be done to remove the lead, but there are treatments for the other causes of haemolytic anaemia.

I agree with others, getting the right tests to identify what is going on should happen before a depression diagnosis. There is a lot of absurd and non scientific clap trap out there about mind and body ...but very little evidence that this is anything above suggestion bias. Sadly this armchair conjecture passes for science in Some quarters of psychology.

I’ve battled through with my GP ...but I’ve needed to get the results and research (like you are doing) to get anywhere. This has lead me down quite a few rabbit holes of crazy theories and dead ends, but I believe eventually the truth will emerge.

Even with definitive lead poisoning ...I am struggling to get my son and wife tested who has been drinking the same water.

I hope you get to the bottom of what is causing your low haemoglobin.

[ENG76 in reply to Slothlike]

Sorry to hear about the lead poisoning, how are your hands and feet responding? It's great you and your family are no longer exposed to the lead at this point. Are they showing symptoms as well?

[Slothlike in reply to ENG76]

Hand and feet still numb but hopeful for other symptom improvements now the source has been removed (around 14 months now).

There’s not a lot of info on what to expect.

My wife had a series of miscarriages before being diagnosed with low thyroid so this may or may not be related to the lead. I’m more concerned about my son since lead can affect brain development in children. Just be peace of mind really.

[ENG76 in reply to Slothlike]

Hopefully the levels of lead were low enough not to effect him. How old is your son? Does he seem to be doing OK developmentally? The human body is pretty amazing at what it can overcome.