A year ago I had a stomach condition where i lost weight but after a time it came back. I am talking to my Dr next week and want to get to the bottom of my problem symptomatically is occasional Fatigue and random early morning BP spikes (e.g. 200/90 normal is 125/75). I have been proscribed Ramipril but all those give me problems. It seems to me (also being 75) I am malabsorbing (ignoring the Blood Counts) these vitamins. For the Blood Counts I await opinion of a specialist as I have non Hodgkin's in the family. My WBC has been around 1.0 since 2014.
Opinion on the deficiencies appreciated.
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omits
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Thanks. The only symptoms I have are occasional fatigue. But Pins and Needles only come on when I am taking either Ramipril or Candesartan (I know as I have taken holiday from both and the problem dying away) so discount, BP aside though. I have had occasional fatigue most of my life. I am taking methylcobalamin B12 (started a week ago) and so far not noticed fatigue unless I work hard (which I perhaps should not do at 75!) but holding off on the Vit D to see what Dr. says. I am now going to go through Sleepbunny's points ready for Thurs when Dr is getting back about 2nd opinion on W/RBCs + Lymphs. I need a strategy to persuade him to do something as I agree they tend to ignore marginal figures. I have done some feed back below as well.
Do you also have results for ferritin (or other iron tests) and are there more results from FBC (Full Blood Count) you haven't posted?
It can become very tricky to interpret full blood count results in a person who has B12 deficiency (and/or folate deficiency) as well as iron deficiency.
B12 deficiency (and folate deficiency) can lead to enlarged red blood cells (macrocytosis).
Iron deficiency can lead to small red blood cells (microcytosis).
One deficiency can mask the effects of another.
UK guidelines suggest that people with the symptoms of B12 deficiency should be treated even if serum (total) B12 is within range.
There is a lot of information below so I suggest you take at least a week to look through it.
Some of the links I post below may have details that could be upsetting.
Do you have symptoms consistent with B12 deficiency?
If you click on "project documents" then on "consultation comments and responses" it gives a good insight into current issues around diagnosis and treatment (over 40 pages).
Local B12 deficiency guidelines
Each CCG (Clinical Commissioning Board/Health Board/NHS hospital trust in UK is likely to have its own local guidelines on treatment/diagnosis of B12 deficiency. Might be worth tracking down the local guidelines for your area of UK and comparing the info in them with BNF, BSH and NICE CKS links.
Some local guidelines have been posted on forum so try a search of forum posts using terms "local guidelines" or try an internet search using "name of CCG/Health Board B12 deficiency guidelines" or submit a FOI (Freedom of Information) request to CCG/Health board asking for access to or a copy of local B12 deficiency guidelines.
See blog post below if you want to know why I suggest that UK forum members should find their local guidelines.
Sometimes the route to better treatment/diagnosis is through seeing a specialist although seeing a specialist is no guarantee of better treatment or getting a diagnosis. There are some specialists who lack understanding of B12 deficiency.
If you have neuro symptoms, I would expect you to be referred to a neurologist.
If neuro symptoms are present and your symptoms are consistent with B12 deficiency, I would expect you to be referred to a haematologist. If GP is reluctant to refer (referrals cost money) then worth trying to get GP to write to a local haematologist asking for advice on how to treat you.
If gut symptoms are present, have you been referred to a gastro enterologist?
Gastro specialist should be able to spot signs of gastritis, signs of PA, Coeliac, H Pylori infection etc.
NICE guidelines - when to refer B12 deficient patient to a haematologist and gastro enterologist
Links to forum threads where I left detailed replies with lots of B12 deficiency info eg causes and symptoms, more UK B12 documents, more B12 books, B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.
What some forum members have found, including myself is that some GPs find it hard to understand that it is possible to have severe B12 deficiency symptoms with a serum B12 result that is within range.
I had over 40 typical B12 deficiency symptoms including dementia symptoms and spinal symptoms with most serum B12 results between 300 - 500 ng. I did have one below range serum B12 result for which they only gave me one set of 5 or 6 loading injections then they wouldn't give me any more.
Sadly I trusted them and didn't realise till several years later that I should have had a different pattern of treatment ... I had many neuro symptoms (see BNF Hydroxycobalamin link).
Functional B12 deficiency
This is where there is plenty of B12 in the blood but its not getting to where it's needed in the cells.
MMA, Homocysteine and Active B12 ( Holotranscobalamin/HoloTC) are tests that can help to diagnose functional B12 deficiency.
If your symptoms are consistent with B12 deficiency but GP refuses to treat you due to your levels being "normal" I suggest putting queries about treatment/diagnosis into a letter to GP. See letter writing link in other reply.
Useful quotes to include in letters and conversations
From Summary of BSH Cobalamin and Folate Guidelines
"In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment"
"If the clinical features suggest deficiency then it is important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features"
From NICE CKS (Clinical Knowledge Summary) B12 deficiency
"Note: clinical features of vitamin B12 deficiency can occur without anaemia and without low serum levels of vitamin B12"
Best pieces of advice I ever got were
1) to always get copies of or access to test results and medical records
2) to get hold of local CCG guidelines on B12 deficiency
If GP says they can't treat you due to the guidelines then you could ask them to show you the guidelines they are referring to.
If they can't show you a copy there and then, ask for the title of the guidelines and then you could submit a FOI (Freedom of Information) request to GP surgery asking for a link to or a copy of these guidelines.
"I am taking methylcobalamin B12 (started a week ago)"
Supplementing with B12 without a confirmed diagnosis of B12 deficiency, can make it more challenging to get a diagnosis.
Thanks again. Ferritin result? No. As I understand it that test is not made if the Iron results are OK as they seem to be and haemoglobin is 138g/L and MCVol is 91fL so within range si I guess that is why it is absent.
PS I have low Vit D. Dont know if I mentioned that 31 (>75) so really low.
"For people with suspected iron deficiency anaemia, arrange a full blood count (FBC).
If results of the FBC show a low haemoglobin and low mean cell volume (MCV) check the ferritin level — check the ferritin level in all people with an MCV less than 95 femtolitres."
Thanks nelie237 I did give those figure above and they appear to be in range and RDW is 13.2% so wel in range. It's so bloody complicated and confusing!
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