Can someone please advise on these blood tests please.
My mum is 75, was diagnosed many years back with fibromyalgia for which she is on morphine. However still gets terrible pains. Her feet are almost always freezing and has burning legs also. She has no pins and needles altho her morphine could be masking that ?
These are the first bloods she has had checked in about 4 years
Edit.. she has been on lansoprazole for about 20 years
Bloods
Bloods
Hi,
Her serum B12 result was within normal range but not very far up the range.
Her folate result was at bottom end of the normal range.
Her Vitamin D level looks like it's in the "insufficient" part of the range although I can't see the result.
NICE guidelines Vitamin D deficiency in Adults
cks.nice.org.uk/topics/vita...
Has she got the symptoms of B12 deficiency and folate deficiency?
If yes then my understanding is that she should be treated.
Symptoms of B12 Deficiency (folate deficiency also mentioned)
pernicious-anaemia-society....
b12deficiency.info/signs-an...
b12d.org/admin/healthcheck/...
cks.nice.org.uk/topics/anae...
b12-institute.nl/en/symptom... (B12 Institute Netherlands)
Symptoms of Peripheral Neuropathy (damage to peripheral nerves)
nhs.uk/conditions/periphera...
Peripheral neuropathy can be associated with B12 deficiency and sometimes with folate deficiency.
Neurological Consequences of B12 Deficiency
PAS news item
pernicious-anaemia-society....
NICE CKS B12 deficiency and Folate deficiency
cks.nice.org.uk/topics/anae...
I think I left info that might be useful on some of your other forum threads.
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.
Some of the info will be specific to UK.
healthunlocked.com/pasoc/po...
healthunlocked.com/pasoc/po...
healthunlocked.com/pasoc/po...
I was diagnosed with fibromyalgia but have no fibro symptoms providing I get enough B12.
I am not medically trained.
Thankyou so much for your reply.Her gp has prescribed vit D supplements and wants to test her kidney function again in 4 weeks...however there has been no mention of her b12, folate, and her elevated ferritin level.
I have read that increased ferritin could be down to inflammation, she has been told she has arthritis.
But her MCHC is low.. so possibly low iron ?
Her main symptoms are severe pain.. for which she takes morphine but doesn't alleviate all her pain.
I have edited the post as I wrongly put restless legs.. she tells me she gets burning feelings in her legs.. her feet are always frozen.. pelvic and hip pain.
I asked her if she got any pins and needles and or numbness.. she says not but could that be masked by the high dose of morphine?
I'm just very concerned that she has been labeled with fibromyalgia and taking high dose opioids when it could be down to deficiency.
Especially when she has been on lansoprazole for over 20 years.
As you know I was diagnosed with b12 deficiency and it seems my granddaughter also has a problem.
I just don't know how to best advise her...
Scientist, not medic.
The MCHC is best ignored. The MCH is a better indicator, and that's well normal. The MCV likewise. 60 years ago, the MCHC was a useful indicator, but times have changed, and now it's a bit too affected by other things, that it's even more artefactual than many of the magic numbers we generate. Ferritin and serum iron are far better indicators of iron status, but at the moment, I really wouldn't start chasing that one!
Good luck. There's good advice on here.
ThankyouI appreciate your input 😀
Is there anything else on those results that needs addressing ? Or you can suggest any other tests?
Her gp has only prescribed her vit d ..
The rest of the results look fairly 'ok' to me. There is much to be said for taking things one at a time.
When results are reported with reference ranges, the ranges are typically +/- 2 Standard Deviations. This assumes that the results are normally distributed [which isn't always the case] but the +/- 2SD range only covers 95% of the normal population. This means that one in twenty 'normals' may fall in the =/- 3SD range, so whilst still normal, they're classed as out of range. If you measure 20 things you'll be very lucky not to find something outside the reference range.
Yes I agree.. My main concern was that she was going to be b12 deficient..as I have been diagnosed.. and also my granddaughters is very low also.. which is why I persuaded her to get tested.. and also the fact that she is always in extreme pain
Hi again. To add insult to injury, the distribution of Serum B12 results certainly isn't a Gaussian distribution; it's skewed. Which means that we get larger numbers of results in the lower end of the range, and there are relatively few in the high end. It make life computing 'reference ranges' particularly challenging.
There's probably plenty of reasons that her result is lower but still normal, including treatment that can interfere with absorption. If she wasn't on some of the tablets her B12 might be higher, but her symptoms of other things might be rather more severe.
This is definitely a case of [however hard to swallow] discussing with the GP and being guided. Sorry I can't be more helpful, but it's the GP's job, not mine!
Yes.. I can't see the lansoprazole helping at all with her b12..It's a shame our gps aren't more knowledgeable in all things nutritional or automatically did a referral. .. but we don't live in a perfect world...
Don't get me started... 😱 Keep smiling. It frightens the 💩💩💩 out of them!
"Especially when she has been on lansoprazole for over 20 years."
PPI drugs have been associated with low B12 levels in some studies.
NHS lansaprazole
nhs.uk/medicines/lansoprazole/
BNF lansoprazole
bnf.nice.org.uk/drugs/lanso...
PPI drugs and B12 deficiency
nhs.uk/conditions/vitamin-b...
pulsetoday.co.uk/news/clini...
Misdiagnosis of B12 deficiency as other conditions
b12deficiency.info/misdiagn...
Burning feelings can be a sign of neuropathy (nerve damage).
There are many causes of neuropathy.
B12 deficiency and folate deficiency are two potential causes.
Diabetes is another potential cause.
Has she been referred to a neurologist?
I've just noticed that her serum creatinine levels are just above range.
What has the GP said about this?
Has GP ordered other tests for kidney function?
Link about creatinine test
labtestsonline.org.uk/tests...
Does your mum's GP know that there is a family history of B12 deficiency?
Has your mum showed you any older serum B12 results?
I wondered if her levels of serum (total) B12 have dropped significantly since last tested.
I am not medically trained.
Also I wondered if she's had a full panel of iron tests.
Just spotted that her Egfr (estimated glomerular filtration rate), a kidney function test appears to be below range if I'm reading it correctly.
Does it say
58 ml/min with a ref range of 90 - 200 ml/min?
Her potassium appears to be just above the bottom of the normal range.
What has the GP said about this?
At least GP is testing her kidney function again.
I've just noticed that her serum creatinine levels are just above range.
Yes and also her neutrophil is below.. I could be wrong but I think they point to decreased kidney function?
What has the GP said about this?
She has not yet spoke to her gp
Has GP ordered other tests for kidney function?
She has an appointment in 4 weeks for further bloods.. I presume because of this..the receptionist told her to drink more water
Does your mum's GP know that there is a family history of B12 deficiency?My mum.hasnt yet spoke to her gp.. she asked the health care worker that was doing my step dad's bloods for his prostrate cancer to do hers . She told her of the family history which is why she did the tests she did
Has your mum showed you any older serum B12 results?
She has only just got the NHS app on her phone.. I can check next time I see her
I wondered if her levels of serum (total) B12 have dropped significantly since last tested.
Her B12 level about 4 years ago was 221 I think.she doesn't eat much but what she does eat is healthy
She hasn't had a full iron panel done but I will get her to order that when she goes next
A doctor now deceased said that Fibromyalgia was untreated Hypothyroidism. Have they done any Thyroid tests? Suggest you go on the sister site on here for Hypothyroidism advice. Often found alongside Pernicious Anaemia. Good luck.
Thankyou.. I was going to suggest to her that she get thyroid checks done
Your mum should ask GP about haemochomatosis. It's a build up of iron but I don't know what type of iron blood tests are required for diagnosis. Apparently it is frequently overlooked. It causes pain and tiredness and damages organs in body and joints. Regular removal of a pint of blood is the main treatment. Men show symptoms in their 30's, women in their 60's - blood loss during periods slows build up. My friend had this condition. Untreated it kills.
Regards B12 and advice above - it is very likely lanzoprazole it having some bad effect. If no luck with doctor supplementation may be worth a try.
Thankyou.. I had looked into condition when I saw how high her ferritin was.. its been that high for years now and has never been looked into.. I will get her to get full iron panel done
Iron Studies
(Haemachromatosis is mentioned)
labtestsonline.org.uk/tests...
NHS link about haemachromatosis
Horrified to read that your Mum has been on Lanzoprazole for 20 years — a powerful PPI.,which should never be taken for such a long time . This will have lowered her stomach acid substantially, or even have negated it completely. This will lead to B12 deficiency and poor absorption of other vitamins , minerals and trace elements . B12 injections are called for if she cannot discontinue Lansoprazole . B12 Tablets will not benefit her.
Those were my thoughts.. but her B12 has come back at 215.. so her gp isn't concerned.. only about her vid D .Because of her many years on lansoprazole I persuaded her to have these tests as her b12 hasn't been tested for over 6 years.
I have b12 deficiency and it looks like my granddaughter does also.. so even more reason for wanting her tested.
At the moment she is taking vit d prescribed by her gp.. having fortified cereal every day and eating a healthy diet.
She is having follow up tests in September for her kidney function and then tests in October for her vit d ...that's all...
I'd appreciate blood result advice please?
Advice for my daughter please - possible PA?
Advice needed regarding doctors treatment of low b12 and low folate, please. 
Blood tests advice please
