GP says I am not anaemic but I am B12 deficient. I am confused!

[Hebe2020]

Hello lovely PA people. Can you please help me understand the conversation I have had with my GP? I have recently had blood tests showing an elevated MCV and a B12 deficiency. She was proposing to treat with two injections then oral supplements. I said I was concerned I might have PA and she said I was not anaemic because I had a full blood count and had had adequate haemoglobin levels for years. I pointed out that elevated MCV is a sign of magaloblastic anaemia but she reiterated I am not anaemic. I am confused, can someone please put me right? On a positive note she agreed I could self inject the remainder of the six B12 injections so, on a practical level I am satisfied in the short term and have another telephone appointment later this week to discuss my other ongoing health issues.

[JanD236]

Unfortunately your doctor has misunderstood the illness.

The name ‘pernicious anaemia’ should probably be replaced by the more accurate ‘autoimmune immune atrophic gastritis’. If I’ve remembered what I’ve read on this forum correctly, 20-25% of people with PA do not suffer anaemia.

What else could be causing your B12d/high MCV? Assuming you’re not vegan it’s likely that PA is the cause and therefore oral supplements will not help treat symptoms.

I would press your GP to treat you in accordance with BNF guidelines which say that after loading doses you should be given an injection every 2 or 3 months. (Although if you have neurological symptoms you should continue to receive every other day injections until no further improvement).

[Hebe2020 in reply to JanD236]

Thank you for your comments. I think you’re right and she is confused. I have six injections now, although I will have to self inject the last four, and will see how I feel. I do have gastric issues so the cause of the deficiency is quite possibly that. Sadly, I was unable to speak to her until after the first injection so IF test is compromised but I will persevere with my attempts to have my health issues addressed, despite a certain lack of confidence in her!

[JanD236 in reply to Hebe2020]

Gastric issues are part and parcel of PA as the immune system has attacked the stomach lining which in turn reduces its ability to produce acid (and intrinsic factor). If you’re not producing sufficient acid you can’t digest protein properly and this undigested protein passing through your gut causes havoc with your gut flora.

I find that raising my stomach acidity (I use betaine hcl & pepsin, others use lime juice or cider vinegar) and using a good quality probiotic with prebiotic supplements/food help.

As a double whammy your immune system might also produce antibodies to intrinsic factor, just to make absolutely sure you aren’t able to access the B12 in your animal protein food.

[Barneyboy48 in reply to JanD236]

The other things that can affect gut absorption are inhibitors. Lanzaprozol, Omeprazole etc. I have to take these to prevent my heart medication from damaging my gut lining. Aspirin is a big gut rotter.

Unfortunately, some GPs dole these out like Rennies or Gaviscon, for any old indigestion complaint so its no wonder more and more people are deficient in B12.

I think the increase and availability of non-steroidal anti-inflammatory drugs hasn't helped. Drugs like Iboprofen and Nurofen are notorious if taken over long periods without breaks or inhibitors.

The double whammy is that the inhibitor medication also prevents the gut from absorbing certain nutrients efficiently.

[Nackapan]

K woujd also ask for an intrinsic factor antybody test before the injections start! and folate vit d

[Hebe2020 in reply to Nackapan]

Sadly, too late for that. I tried to speak to the GP before my first injection and left a message expressing my concerns but did not hear before my appointment for an injection. I felt so lousy I took the injection. I will persevere, though!

[TFH1]

I believe that when you used the word anaemia, she thought you were referring to iron deficiency anaemia. Either it was just a simple misunderstanding, or your GP needs to be directed to some resources where she can read up on pernicous anaemia. Can you do a follow up appointment with someone else? I'd bring the NICE guidleines along stating appropriate course of action for your situation - frequency of injections depends on whether you have neurological symptoms (numbness, tingling, brain fog etc). It's also important that they establish the cause of your low b12 - if it's diet related, oral medication fine. If it's PA, first step would be to try and identify that with a test for intrinsic factor antibodies and you should have b12 injections for life. cks.nice.org.uk/topics/anae...

[Hebe2020 in reply to TFH1]

I didn’t mention anemia I mentioned PA. in her notes she said “explained she was not anaemic and her B12 was mildly low”. I think she just doesn’t understand. It sometime feels like the National Health Prevention Service! I have another telephone appointment on Thursday when I will persevere.

[TFH1]

What was your b12 level?

[Hebe2020]

154 ng/L [180-915] reference range. I tried to make the point that if I was out of range I was deficient and should be treated in accordance with the guidelines. She was quite dismissive.