Low B12

[meme]

Blood test for B12 was 177ng/L. range 197.0-771.0

I asked for injections from GP. He said no as they only give injections for pernicious Anaemia and to get a multi vitamin with B12 and suggested retesting in the new year. Is this the correct treatment ?

[fbirder]

Do you eat lots of meat/fish? If so then pills will be useless.

Ask the doctor how he knows you do not have PA? The only way to tell is a positive result for IF antibodies. But a negative result is meaningless. Print this out - onlinelibrary.wiley.com/doi... - and show the doc this paragraph -

The finding of a low total serum cobalamin level may be further evaluated by testing for anti-IFAB. If positive, the test has a high positive predictive value (95%) for the presence of pernicious anaemia (Toh et al, 1997), with a concurrent low false positive rate (1–2%) i.e. a high specificity. It identifies those patients with a need for lifelong cobalamin replacement therapy. IFAB is positive in 40–60% of cases (Ungar et al, 1967), i.e., low sensitivity, and the finding of a negative IFAB assay does not therefore rule out pernicious anaemia (hereafter referred to as AbNegPA)

Then ask him to look at the British National Formulary entry for hydroxocobalamin. Where the first entry is -

Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency

By intramuscular injection

Adult

1 mg every 2–3 months.

So he should be giving you injections to prevent you from getting macrocytic anaemia.

[meme in reply to fbirder]

GP has agreed to test for antibodies but insists B12 injections will only be given if positive. She still thinks multi Vit with B12 is enough.

[fbirder in reply to meme]

Write a letter. Include that paper by the BCSH with the relevant bit highlighted.

[Sibby123 in reply to fbirder]

fbirder you have significant amount of knowledge with P.A. and b12 defieincy , sorry I know this is not my post but a quick question that may relevant for other people . In your opinion if I am displaying b12 deficiency but at the time of the blood test I was taking b complex supplement , my results were normal b12 and high folate do you think I could still have a deficiency?

[fbirder in reply to Sibby123]

How 'normal' was it? What was the number, the units and the range?

Something like 150 pmol/L (115 - 500 pmol/L)

[meme]

I eat, Meat ( usually venison or lamb or pork) and fish ( usually salmon, tuna, crab, or mussels) one from each list a week. Veggie the rest of the week. 2 eggs a week. Marmite. Full fat Greek yogurt, nutritional yeast, kifier, cheese(all varieties). Lots of beans and veg. Potatoes, rice(all types ) and pastas.

GP said there was no sign of anaemia or enlarged red blood cells.

He said we could request an antibody test.

Should I try B12 supplements and retest B12 in the new year?

[Nackapan in reply to meme]

What was the conclusion ?

[meme in reply to Nackapan]

Negative for PA.

GP not at all concerned with B12 level.