Can anyone tell me what these blood results mean

[Cultivate]

I have pernicious anaemia and have been suffering really badly with head shaking, arm shaking and weakness also im really tired. Could this be B12 related?

Here are my results

Full blood count - FBC

Haemoglobin estimation131 g/L115 - 160 g/L

Total white cell count4.15 10*9/L4.00 - 11.00 10*9/L

Platelet count209 10*9/L150 - 400 10*9/L

Mean corpuscular volume (MCV)86 fL78 - 100 fL

Haematocrit0.430.37 - 0.47

Red blood cell (RBC) count4.97 10*12/L3.80 - 5.80 10*12/L

Mean corpusc. haemoglobin(MCH)26.4 pg27.0 - 32.0 pg

Red blood cell distribut width16-

Neutrophil count2.07 10*9/L2.00 - 7.50 10*9/L

Lymphocyte count1.46 10*9/L1.00 - 4.50 10*9/L

Monocyte count0.47 10*9/L0.20 - 0.80 10*9/L

Eosinophil count0 10*9/L0.04 - 0.40 10*9/L

Basophil count0.05 10*9/L- 0.10 10*9/L

Large unstained cells0.1 10*9/L- 0.60 10*9/L

Percentage hypochromic cells13 %- %

Monocyte count0.38 10*9/L0.20 - 0.80 10*9/L

Eosinophil count0 10*9/L0.04 - 0.40 10*9/L

Basophil count0.03 10*9/L- 0.10 10*9/L

Large unstained cells0.12 10*9/L- 0.60 10*9/L

Percentage hypochromic cells10 %- %

Serum total 25-OH vit D level50 nmol/L50 - 100 nmol/L

Serum ferritin20 ug/L10 - 322 ug/L

Calcium-adj,Alb,PO4

Serum adjusted calcium conc2.32 mmol/L2.20 - 2.60 mmol/L

Serum albumin39 g/L35 - 50 g/L

Serum inorganic phosphate0.74 mmol/L0.80 - 1.50 mmol/L

Serum alkaline phosphatase103 iu/L30 - 130 iu/L

26-Nov-2020

Serum vitamin B12989 ng/L211 - 911 ng/L

Liver function test

Serum total bilirubin level7 umol/L2 - 21 umol/L

Serum ALT level24 iu/L- 40 iu/L

Serum albumin43 g/L35 - 50 g/L

Serum alkaline phosphatase106 iu/L30 - 130 iu/L

Serum TSH level1.9 miu/L0.20 - 4.00 miu/L

Urea & Electrolytes

Serum sodium140 mmol/L133 - 146 mmol/L

Serum potassium4.5 mmol/L3.5 - 5.3 mmol/L

Serum urea level5.6 mmol/L2.5 - 7.8 mmol/L

Serum creatinine68 umol/L49 - 90 umol/L

GFR calculated abbreviatd MDRD79 mL/min/1.73m2- mL/min/1.73m2

AKI warning stage

Serum ferritin7 ug/L10 - 322 ug/L

Full blood count - FBC

Haemoglobin estimation125 g/L115 - 160 g/L

Total white cell count4.94 10*9/L4.00 - 11.00 10*9/L

Platelet count258 10*9/L150 - 400 10*9/L

Mean corpuscular volume (MCV)80 fL78 - 100 fL

Haematocrit0.410.37 - 0.47

Red blood cell (RBC) count5.1 10*12/L3.80 - 5.80 10*12/L

Mean corpusc. haemoglobin(MCH)24.5 pg27.0 - 32.0 pg

Red blood cell distribut width15.9-

Neutrophil count3.16 10*9/L2.00 - 7.50 10*9/L

Lymphocyte count1.2 10*9/L1.00 - 4.50 10*9/L

Monocyte count0.41 10*9/L0.20 - 0.80 10*9/L

Eosinophil count0.05 10*9/L0.04 - 0.40 10*9/L

Basophil count0.03 10*9/L- 0.10 10*9/L

Large unstained cells0.08 10*9/L- 0.60 10*9/L

Percentage hypochromic cells30 %- %

Serum total 25-OH vit D level38 nmol/L50 - 100 nmol/L

Serum folate14.1 ug/L5.4 - 24.0 ug/L

HbA1c levl - IFCC standardised38 mmol/mol20 - 41 mmol/mol

Thankyou

[Gambit62 Administrator]

Have you discussed with your GP? - the only measure that seems to stand out is that your MCH is a little on the low side, if I have read the results correctly - and it isn't clear if the 26/11 is an early set of results or a later - if an earlier then it would look like the MCH is actually improving.

B12 anaemia is associated with larger rounder red blood cells which would mean raised MCH so, this isn't consistent with B12 deficiency.

The high B12 result in November is presumably due to injections and wouldn't be something that most of us on this forum would see as significant or regard as having relevance to when you needed injections.

If these are symptoms that disappear when you have an injection and then return before your next shot it may be that they indicate that the maintenance regime you are on isn't right for you - but if they don't bear any relationship to injections it would imply they are due to something else.

[Cultivate in reply to Gambit62]

Thankyou for your reply. Yes they were earlier results so it has improved. What is MCH. Is it related to iron? I am just starting injections every other day as I was having them every three months before then monthly for the past 4 months. Does my folate and ferritin look fine?

[Gambit62 Administrator in reply to Cultivate]

ferritin was a bit low in first results and marginally better in second steps - its quite a good indicator of iron status so might indicate iron deficiency - which would be consistent with the low MCH (the average amount of haemoglobin in your red blood cells). There have been some cases of GPs acting just on serum ferritin without looking at an iron panel and patients getting suffering iron overdoses as a result.Folate is responsive to diet as it isn't stored elsewhere in the body (unlike B12) and the normal range is therefore quite consistent across individuals - so your result isn't implying folate deficiency.

PA can affect absorption of other minerals and vitamins besides B12 - most common are folate and iron.

Really suggest you discuss with your GP

[Cultivate in reply to Gambit62]

Ok I will. Its just so hard to get an appointment and so rushed. Thankyou

[Cultivate in reply to Cultivate]

When self injecting do you tell your GP?

[Cultivate]

Im in th UK and I don't think they like you doing it

[waveylines]

Im in the uk and my GP lets me self inject -subcut. Im on a high regime of injections. You are describing neurological symptoms so you should definately be on alternate days. I had terrible postural tremors including head shaking, legs, arms/hands shaking, my mouth shook when I tried to smile, I felt my legs were weak and developed double incontinence, eye twitching, couldnt stand for long. These tremors developed over a ten year period. For me daily injections AND going gluten free has made a massive difference. My tremors after eight months of adding gluten free to the b12 regime are now very mild and mostly unnoticable to others, I can stand for long periods, get far less tired and my incontinence has improved hugely but not resolved fully. My GP thinks I have Gluten Ataxia, been waiting since March to be seen by the Ataxia clinic.

I was blaming everything on B12 issues but it isnt always the case so you are very wise considering wider possibilities as well, especially if you are already on a high dose regime of b12 injections.

[Marz]

VitD is low and around 100+ is considered optimal. Are you supplementing ?

Your TSH looks fine but that is a Pituitary hormone so does not reveal the activity of your thyroid. Ruling out Hashimotos would be appropriate as this condition can be the cause of poor vitamin and mineral uptake and is auto-immune as is PA.

grassrootshealth.net

A full Iron Profile is needed as it is often suggested a level around 70 is good.

I am a Hashi's sufferer - no PA - B12 issue due to surgery - so not a medic of any sort 🌻

[FlipperTD]

Scientist, not medic, but very familiar with FBC results. This will be a bit lengthy but I'll try to keep it simple. This isn't medical advice, it's just explaining what appears to be going on.

Virtually everything you list is within normal limits except the MCH. The analyser that has been used is one that reports % hypochromic cells too, and this links in with the MCH. The RDW also reflects this. It's difficult for me to say whether things are improving or getting worse as I can't see any dates of testing.

How are these figures linked?

MCH is 'Mean Cell Haemoglobin' and is in effect Haemoglobin/Red Cell Count, so the average amount of Hb per red cell. Red Cells have a life of about 110 days before they're replaced, so things change slowly. If the MCH commences to fall, [usually the MCHC and the MCV will fall at the same time] then that indicates a lack of iron. so, iron deficiency anaemia will manifest itself early by a falling MCV before the Hb falls.

RDW is 'Red Cell Distribution Width' which is a measure of the range of sizes of red cells. Given the 110 day rule, you're replacing abut 1% of your red cells per day. If you're making smaller cells because of a lack of iron, then the distribution gets wider and wider, and about 50 days into this process it will reach a maximum when you've got lots of big, and lots of little cells. Then it's going to fall again once all your cells are smaller. Treatment with iron [under medical supervision] reverses this process. It is vital that folate and B12 levels are adequate because these are needed to make the new cells.

% Hypochromic cells: This is a feature of one manufacturer's analysers, and in effect reflects the production of smaller, paler cells, reflecting the MCH changes.

So, in summary, if the MCH falls over time, then you're probably running out of iron. You're using more than you're taking in. If the MCH [and MCV] rise over time, you're making bigger cells, and this can be due to recovery due to iron replacement, or it could be a developing deficiency of folate [or B12].

If it's a deficiency, then these changes will reverse slowly on treatment, and once the deficiency is corrected then the 'old' cells will be out of your circulation in about 4 months.

Don't panic, speak to your doctor, and listen to the answers. Just because your Hb hasn't dropped to the 'anaemic' level doesn't mean nothing has to be done.

Keep in touch with this forum as there is a lot of knowledge here. Good luck.