Hello everyone!
I need your precious feedback on a case that has risen up on me lately:
Is it possible to have a folate deficiency with normal lab values?
I had a blood test which came up with normal folate values ( 7.2 ng/ml with a normal value of >5.4).
The labs also resulted to a higher than normal homocysteine.
My Dr ordered that I take folate as a supplement to counter the increased value of homocysteine.
Is this normal? Does this mean that i am deficient in some way on folate?
It does appear to be quite low in range. Short term high dose is often prescribed.
Then bloods repeated.
A maintenence dose of 200- 400mcg of fol,ic acid often needed.
Sounds like you are getting thorough testing if homocysteine tested.
Hope you get an explanation of other full blood results
Thanks for your answer Nackapan ! Indeed, i got given a dose of 500mcg 3 times a week for a month, and then repeat exactly as you said! I don't know about the "thorough" i am not even sure i know what homocysteine is. Just that its a marker for future issues (thrombosis).
It seems you know your stuff so i will ask one more in case you know:
You mentioned other blood test results. I got them and everything was good except for platelets (MPV & PDW) which were both high. Is this an indication of anemia or something?
Ps: i am sure you understood this but i have Very little knowledge on blood tests (except thyroid since i am a hashimoto), so amy feedback will be very well received!
Have you had b12 tested?
No, it was not on the current tests. But i have done it some times in the past and it's in the normal range (its always around 360 on a range of 160-970)
I would certainly get this tested, 360 can be borderline deficiency and would certainly raise homocysteine.
Oh so 360 is considered low? I thought thst it being i the middle, it would be a very good value. Thanks for your recommendation, i will test it as well. And if it comes yp again around 360 would you recommend that i supplemented with b12 only, folate only or both?
B12 shojjd be treated before fokatd if a deficiency.
As you say your b12 is in range.
MMA is another test done on occasions when b12 in range but you have b12 deficiency symptoms.
If Mma high and homocysteine it csn indicate b12 is not getting to cell level.
It's called functional b12 deficiency.
Did you have an Intrinsic factor anti body test?
This does pick up about 50% of this with PA .
Sonr need s few tests to get z positive.
So z negative dies not rule PA out.
As and autoimmune conditions anc you have hashimoto thyroid condition.
Others on here have a more scientific explanaton.
Iron ,ferritin ,vit D ,
Folate and b1e can all be low if an auto immune problem or an absorption problem.
Keep s log of your symptoms.
Hoping you csn distinguish between your thyroid problems.
Many symptoms do overlap.
I cannot help you with platelet levels.
It all hax yo be looked at together.
Hope you get more tests ,explanations what they ard looking for.
Things eliminated and some answers
No worries, you offered me a lot of information to search for. Thanks a lot for your information and help!!!
Having a level of 360 generally -( ng/L or pmol/L ? ) - gives you a known baseline which is useful. It could have taken a bit of a nosedive - so worth having checked again. I believe in Greece, you keep your own medical records - so easier to check back over time, see in what direction B12 is heading.
Methylmalonic acid (MMA) serum level can increase quite quickly if B12 deficient, as it needs to make a link-up with B12. If the deficiency gets addressed (in UK, this starts with a loading dose of 6 injections within a short period of time) the MMA should rapidly return to normal levels as it makes the links to move on to cell/tissue level. If it remains high, there could be a functional problem where it cannot easily reach tissue/cells in useful amounts- but for a diagnosis of functional B12 deficiency, first renal problems and later small intestine bacterial overgrowth (SIBO) would have to be ruled out to be certain.
It could be worth seeeing what both MMA and homocysteine are doing, but if I had to choose one, I'd go for MMA. Mine remained raised for three years despite frequent B12 injections, although homocysteine was "normal".
With B12 deficiency caused by pernicious anaemia (PA), an autoimmune condition , other autoimmune conditions can be a problem. Hashimoto's, Grave's disease, vitiligo, psoriasis come to mind although there are another 100 probably ! You could have an Intrinsic Factor antibody test (IFab) to see if you do have PA - but only 40-60% of those with PA will test positive. I'd start with another serum B12 test first.
If there is a B12 deficiency, this would want to be addressed before folate. Nackapan is absolutely right.
B12 and folate deficiency
Feelong totally alone with Folate deficiency 
B12 normal but folate low normal
Folate deficient 
