My daughter has very low foliate and folic iron levels but they say her B12 and all other tests are OK But I do wonder if her iron levels are so low would it affect her B12 levels?
she has been feeling quite poorly and extremely tired they have given iron tablets for foliate for 3mths and folic 2mths each on 3x a day and 4 x a day which gave her horrible side effects 🙄 she has reduced the amount as said to do by her doctor and will see them in a couple of weeks .I
The best advice I ever got was to always get copies of or access to all blood test results.
There are people on this forum including myself who were told that everything was normal, no action and then they found abnormal or borderline results when they got access to results.
I suggest your daughter checks all her results and notes the actual result and the reference range.
She might want to post her results here but she needs to remove any details that might identify her or any health professional.
If you click on "project documents" then on "consultation comments and responses" it gives a good insight into current issues around diagnosis and treatment.
See Cautions section in above link which says that folic acid should never be given on its own for PA (Pernicious Anaemia) or other megaloblastic anaemias caused by Vit B12 deficiency as this may lead to SACD, subacute combined degeneration of the spinal cord.
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.
Read blog post below if you want to know why I urge UK forum members to find out what's in their local B12 deficiency guidelines.
but please be aware that the symptoms of folate deficiency and B12 deficiency are more or less identical so if she is folate deficient it may not help.Is the folate deficiency dietary (ie lack of fruit and veg in diet). If not and your daughter has a folate deficiency then that increases the chances that she also has an undiagnosed B12 absorption problem.
Iron won't of itself affect B12 levels but if the iron deficiency is causing microcytic anaemia this can mask any signs of macrocytic anaemia caused by folate and B12 deficiency.
If your daughter is adding b12 (b12 tabletts, multivitamin (with b12), b12 injections or energy drinks (Red Bull, Monster etc…) then the b12 test (cobalamin) is totally irrelevant cause its gets too high - not the real value. Use Holotc test (best) instead or Mma.
So she has a parent and a grandparent with PA (Pernicious Anaemia).
She has low folate and low iron.
I'm interested to know what her last few serum (total) B12 results were.
It can be useful to look for trends in blood test results. For example results that are within normal range but have been dropping or increasing over time may be significant.
There was at least one forum member who tested positive on IFA (Intrinsic Factor Antibody) test but was not told at the time.
If not tested in past, I suggest she asks to be tested for PA in a short letter to GP and that she mentions the family history of PA .
If GP is reluctant to test for PA then it is possible to get tested privately in UK.
There is a high street chain of chemists in UK that can do this.
If GP refuses to test for PA, it's helpful to know the reason why as this might help to argue against the reason.
I met a lot of ignorance about B12 deficiency among health professionals and suffered for years as a result. See links about Misconceptions in my other reply.
GPs are unlikely to accept the results of private tests but a significant result in private tests may be enough to nudge them into ordering the same tests or referring to a specialist who can order them.
Might be worth her joining and talking to PAS who can pass on useful info and offer support.
A negative result in the Intrinsic Factor Antibody test does not rule out PA.
Unfortunately, some GPs and specialists may be unaware of this.
Some people have Antibody Negative PA, see diagnostic flowchart from BSH Cobalamin and Folate guidelines in other reply.
Martyn Hooper, chair of PAS, tested negative several times before getting a positive result in IFA test.
He mentions Antibody Negative PA in his book "What You Need to Know About Pernicious Anaemia and B12 Deficiency".
Links to forum threads where I left detailed replies with lots of B12 deficiency info eg causes and symptoms, more UK B12 documents, B12 books, B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.
Some links may have details that could be upsetting.
As sleepybunny has said, either copies or online access to blood results is an eye-opener.
You should also ask the GP to test for coeliac. Per NICE
"If folate levels are low, assess dietary folic acid intake, and if history suggests malabsorption, check for coeliac disease by testing for antiendomysial or antitransglutaminase antibodies (depending on the local laboratory).
The main cause of folate malabsorption is gluten-induced enteropathy. "
It is possible, especially if your daughter has heavy periods. I had very low iron and pernicious at the same time, before the menopause. Your daughter definitely needs to get checked.
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