B12 injections lowering ferritin levels?

[WorkingProgress]

This is another one being bantered about. Is this codswallop too? How can it do this? Facebook forums can be very confusing. Mr fbirder ... do your magic thing as you do and give us the truth please.

Thanks again.

[fbirder]

It is, indeed, tommyrot and balderdash.

Iron levels might drop a bit - if you had macrocytic anaemia, and even then just a little bit and just for a couple of weeks. The body has plenty of iron in reserve. The amount needed to make proper red cells will be a small fraction of the total amount in the body.

That assumes that you aren't suffering from an iron deficiency already. If you are then the ferritin levels might well drop noticeably because of the sudden increase in red cell formation. ncbi.nlm.nih.gov/pmc/articl...

[WorkingProgress in reply to fbirder]

But even then after a little while surely all will stabilise as you continue to eat iron each week by way of liver etc ?

[Nackapan in reply to WorkingProgress]

If you have trouble absorbing b12 you can have difficulty absorbing g enough iron. Folate vit d as well as other things. I've never needed iron before.

I still need iron supplements as a nainteneance but only every other day.

I tried eating more liver and red meat lentils ect .

All it did was raise my cholesterol.

And as I cant seem to absorb b12 I'm back eating as I was. I need to lower cholesterol now.

My ferritin was 61 no supplements and now back to 60.taking iron supplements. Took over a year though.

The other thing is inflammation in the body when ill raises ferritin so you the first figure may not be 'your normal ' we all operate at different levels.

If having low ferritin symptoms best to get it above 50 I certainly felt better when it was back up in the 40s after it dropped .

If on supplements you must have regular blood tests and your doctor aware what you are taking .

Too much iron bad for you.

[deniseinmilden in reply to Nackapan]

Superb reply! 😃

[nellie237 in reply to fbirder]

This is a bit off topic, but I've been reading this forum for a bit and I always respect your posts/answers. Last week my GP tried to tell me that erythropoietin is synthetic (not in the context I was talking about it isn't). I will try to make this as short as I can.

Background

I was dx coeliac in Nov 2020 (blood test >x10 top of range so immediately GF) -I asked for Iron, Folate, B12 & D to be checked in Jan 21 -

Ferritin............................15ug/L (Range 10 - 291)

Folate.............................2.3 ug/L (Range 3.4 - 12.2)

Serum B12.................284 ng/L (Range 211 - 911)

Vit D................................22 (Range 25 - 250)

Prescribed

Ferrous gluconate - stopped 31/3/21

Folic Acid 5mg for 2 months - stopped 26/03/21

Loading doses Vit D - 7 wks only

B12 jabs 1 every 3 wks for 3 months stopped 22/03/21

Re-tested 07/04/21

Ferritin.........................69

Folate...........................18

B12..........................1796

Vit D.............................88

So, all good so far, and now we can ignore it.

On 04/03/21, I had AKI (Acute kidney injury) due to BP meds. My eGFR had dropped from 82 to 29 in a week. 08/03/21 eGFR back up to 57. Latest test 19/04/21 was 73.

I was on PPI's for years but stopped these on 03/03/21. I also have Hashi's since 2007. Endoscope 13/03/21 as over 55 yrs - all OK - presume GF diet working.

Advice Sought

Even though my ferritin level is now good my RBC count/Haematocrit/Haemoglobin are dropping, and MCV is rising again.

If I look at old results 2016 seems like a good indicator of normal for me

RBC Count...............................4.03 (Range 3.6 -4.9)

Haematocrit...........................0.40 (Range 0.315 - 0.44)

Haemoglobin est..................134 (Range 110 - 153)

These were lower at Coeliac dx in Nov

RBC Count.............................3.70

Haematocrit..........................0.37

Haemoglobin est..................125

There was a slight rise on 15/03/21, but since then they have been gradually dropping

Results 19/04/21

RBC Count.............................3.53 (Under Range)

Haematocrit..........................0.34

Haemoglobin est..................119

MCV has consistently been at the top end. In 2016 it was 98, and has been over 100 in the past. Looking at old results folate, B12 & Ferritin have been borderline for years, probably due to both PPI's and thyroid. Recent supplements prescribed reduced MCV to 95.6, but latest on 19/04/21 has crept back up to 97.5. I bought some B Complex but haven't really been able to take them yet due to blood tests getting in the way.

I did a lot of research and I had a conversation with my GP last week that went something like this:-

Me: I've been religiously been taking my iron and really pleased that my blood test 2 wks ago showed that my ferritin has increased to a good level, but my RBC count has been dropping and is now under range, and Haematocrit and Haemoglobin are headed the same way. Is this because I wouldn't have been producing Erythropoietin during the AKI?

GP: Erythropoietin is synthetic

Me: No it's not, the kidneys assess how much oxygen is in the blood and if there's not enough then EPO stimulates the bone marrow to produce more RBC's. Pause... OK, so we can't check that then, how about reticulocytes to make sure that I'm actually producing RBC's?

GP: I don't know if I can request that, hold on........... Yes OK, and recommence the Iron at 1 per day.

Me: And while we're at it I think that I should be tested for PA just in case.

GP: I'm not sure if I'm still able to test that (so looks like GP's are not going to be able to do this in future)......Oh, yes I can.

I can find lots of information about AKI/anaemia due to surgery, where surgery is probably a factor re anaemia, also quite a bit about severe ckd & epo where improvement takes a couple of months, but nothing that fits my circumstances even though not that unusual.

I am a bit concerned that in another month I'll be even worse off and thought I would ask if you've got any info in your library that might be of help.

Thank you for reading, and very sorry for jumping in your thread WorkingProgress.

[Scotlad76]

There are papers in the literature that suggest b12 injections "may" deplete folate, iron or potassium. I take a thriva test for folate, ferretin (and vit D for other reasons) every 6 months just to keep an eye on it.

[fbirder in reply to Scotlad76]

Potassium, yes. But only for a month or so and only if you had macrocytic anaemia.

Iron and folate, no. There is no way that B12 injections can continuously and significantly deplete iron or folate. Go back to the Facebook group and ask them for the exact references.

[Scotlad76 in reply to fbirder]

I'm not on any Facebook groups. Indeed I no longer have a Facebook account.

[Scotlad76]

Folate Feb last year

Folate serum

[Scotlad76 in reply to Scotlad76]

Folate a year and a few months later. I'll save you working out the different units of measurement by telling you my folate levels have halved. I eat plenty folate rich foods.

This is why I test my folate and ferretin.

I think I'll start a folate supplement now.