Hi again. It's good to be back. My doctor did blood tests on Monday and they came back that I'm very anaemic. She said my B12 levels were great. Now I'm on 3 x 210mg iron tablets daily. Unfortunately I've been on Lansoprozole for many years which probably caused the Pernicious Anaemia in the first place along with Gaviscon. I read today that if we are taking Lansoprozole then it completely hinders the absorption of iron. I spoke to my doctor and she said it wouldn't be a problem if I took the iron tablets at least 2 hours before the Lansoprozole. She does not agree that giving the B12 injections earlier is necessary either. Also she thinks that any relief from the B12 patches is more a placebo effect rather than them actually doing any good. She said that the sublingual are really ineffective. I'm not at all well but dont know what to do next. Im so anxious now too. I was looking at overseas providers of Hydroxocbalomin for SI but couldn't find the English Versandapo. e and I contacted another one who dont post outside the EU. Can anyone help me please? Thankyou
Margaret
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Margaret-S
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Your doctor is right about two things - patches and sublinguals are useless if you have PA.
Lansoprazole can, indeed, hinder the absorption of iron, because stomach acid is needed to get iron away from proteins, and also to dissolve it. This only applies to plant sources of iron. Iron from animal blood and muscle comes as haem iron, which is easily absorbed no matter how acidic the stomach contents.
But you can ensure that the iron you take isn't reliant on stomach acid for absorption.
If you're given iron sulfate then you can take it with ascorbic and citric acids. You can buy effervescent tablet that contain both. Ascorbic acid is better known as Vitamin C. These two chemicals can bind with the iron to form a chelate - which is much easier to dissolve that non-chelated iron.
I think that your doctor has prescribed you iron fumarate. This is a form of iron that is already chelated, so should dissolve fairly easily with or without acid.
Two places I've seen that supply Rotexmedica Depot ampoules of B12 are:
I hope you find a way to get the treatment you need.
Some of the links I post may have details that could be upsetting.
"My doctor did blood tests on Monday and they came back that I'm very anaemic. She said my B12 levels were great. "
Have you checked for yourself what your iron and B12 levels were and also folate levels and full blood count?
Best advice I ever got was to always get copies of or access to my blood test results.
I was told on more than one occasion that everything was fine/normal/no action and when I got copies of the results I found abnormal and borderline results on some tests.
What your GP thinks is great and what you think is great could be very different.....
These days I don't accept being told everything is normal unless I have a copy of the results in my hand or on a screen in front of me.
Don't rely on there being evidence of a past diagnosis of PA (Pernicious Anaemia) or other cause of B12 deficiency in current medical records.
If you get proof of diagnosis eg positive test result/letter from specialist confirming diagnosis etc keep a copy in a safe place in case it's needed in future.
"She does not agree that giving the B12 injections earlier is necessary either. "
How often are you getting your B12 injections?
Is it every 3 months?
My understanding of UK guidelines is that patients with neuro symptoms should have maintenance injections every 2 months. Also BNF allows for injections to be given every 2 months even if patient does not have neurological symptoms.
Might be worth asking her politely why she thinks giving a B12 injection earlier is not necessary. Some GPs and other health professionals have misconceptions about B12 deficiency and her answer may give an clue as to whether or not she has a good understanding of B12 deficiency.
Vital to get adequate treatment for B12 deficiency. Untreated or under treated B12 deficiency increases the risk of permanent neurological damage.
Each CCG/Health Board/NHS hospital trust is likely to have its own local guidelines on treatment/diagnosis of B12 deficiency. Suggest you track down the local guidelines for your area of UK and compare them with BSH/BNF and NICE CKS links above.
Some of these local guidelines are not very helpful. See blog post below.
Link has letter templates, covering a variety of situations linked to B12 deficiency, that people can base their own letters to GPs on.
Point 1 in above link is about under treatment of B12 deficiency with neuro symptoms.
Letters avoid face to face confrontation with GP and allow patient time to express their concerns effectively.
Best to keep letters as brief, to the point and polite as possible. It's harder to ignore a letter in my opinion. Keep copies of any letters sent or received.
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