Some clarification please, are B12 folate And iron deficiency Competeting anemia's?

[Steph0077]

hi everyone,

I just wanted to ask a question as I think I understand this but am not 100% sure,

If you have B12 deficiency, folate deficiency, and iron deficiency all togeather which I think could also be, microcytic, macrocytic, and iron deficiency anemia,

do they compete with each to give false blood count to look like your not anemic when you actually have all three?

By way of normal MCV and mean cell haemoglobin levels normal, but the only clue could be RDW heightened,

so if you treated one of the anemias but not the others would the other ones then become apparent?

sorry it’s quite a technical question but I just trying trying to get my very fried brain around this one, all I keep hearing from my GP is your not anemic, but I totally believe I am for various reasons, and I know that b12 deficiency doesn’t alway mean anemia, but saying you hypothetically had all three what would your FBC show? Many thanks in advance 👍🏼❤️

[Technoid]

Pass. I think I would have to graduate haemotology to answer that

[Technoid in reply to Technoid]

Paging FlipperTD

[jade_s]

Yes FlipperTD will be a good person to ask.. but from my limited understanding, what you write is correct. Low b12 and/or folate can cause macrocytosis. Low iron can cause microcytosis. But together, MCV/MCHC may look normal as the effects of low b12/folate & iron cancel each other out, but RDW may be elevated. I believe if they would do a smear & manually look via a microscope, the RBCs would look misshapen (thus high rdw). As an aside, MPV - mean platelet volume - can also be high in B12D.

Fixing one should indeed reveal the others. Except for b12/folate - if you're low b12 & you replace only folate, it will normalize RBCs so that any b12 related anemia disappears. That's why they say taking folic acid can mask b12 deficiency - f.a. makes RBCs look normal even though you may still be very b12 deficient.

So if you would fix iron levels and wait 4 months, you might eventually see macrocytosis, and vice versa.

Also remember you can have severe b12D with neurological involvement *without* having macrocytosis! The literature says around 20% of b12d patients will present with neuro symptoms first, without ever showing macrocytosis.

[Steph0077 in reply to jade_s]

Thank you thats very helpful, I keep getting your not anemic, but I look and feel it, and have deficiency’s in all three, so this would make sense, also I got one of home anemia kits mine came up positive twice and partners negative, it should be something DRs know that can happen if you have all three, especially consultants, even when I was in a&e (Monday) they did not understand it, and that was the lead consultant same when I got to the ward the consultant told me your not anemic and your not b12 deficient (199ng/l levels) was 179ng/l in June been on supplements for 2months bought myself doctor wouldn’t even give those lol and folate was 1.5, I have many neurological problems but hospital dr and Gp said it wasent b12 or folate deficiency related as I wanted deficient, I also have glossitis! It’s bad today burning fat tongue 😣

[jade_s in reply to Steph0077]

Your situation just breaks my heart. B12 is low enough to be treated even if there's no anemia.

After getting kicked out of my GPs office, I ended up SI'ing after getting my first shot from my nurse sister-in-law. Just as well, because the neurologist I saw a few months later was even more useless. B12D isn't on my medical record, which frustrates me, but it's better than stumbling around with 2 numb arms and accelerating cognitive decline. Keep pushing, but at some point you might have to decide what's best for your health. We're here to help either way!

[Steph0077 in reply to jade_s]

That’s terrible that you have had to go through that, I am so sorry ❤️utterly useless bunch of cowboys😡it does actually define belief that this is allowed in 2022🤬

I so get the numb hands arms etc I now wake up freaking out because both my arms are dead it’s happening every day now the blurred vision used to be intermittent now it’s 24/7 it creeps up so slowly that it’s only when you think back to maybe 5-6 years ago and compare your life then that your realise how bad you actually are! I had a business a true passion and energy for life despite overwhelming fatigue on a regular basis (it’s now constant I’m in bed majority of day, I feel drunk with no alcohol and my tolerance is non existent, I blurt stuff I’d never of dream saying to any before, if I upset anyone I’d feel so bad now I say what I like when I like it’s not me though it really isn’t I feel like I’m in the moment forgetting yesterday (literally) and don’t think of tomorrow 😣)

I sit here and think if I had the energy I’d get leaflets printed up stand outside busy places and give them out, I’d phone up the local papers give them my story (might actually do it this week tbh🤔) I’d campaign my butt off for change, but I’m so poorly that I can bearly move lol I like to dream though, and hope that one day when I’m better, I can hrr well others and help make a change🙏 no point in having this new found big mouth if you can’t use it 😂

[Gambit62 Administrator]

B12 and folate deficiency can cause macrocytic anaemias in which red blood cells are larger and rounder than normal. Iron deficiency can cause microcytic anaemia in which red blood cells are smaller than normal.It is possible to have both, with one masking the other when looking at the average size of blood cells, but logic says that RDW (red cell distribution width) should be high in that case.

There are other causes of microcytic anaemias and macrocytic anaemias, so a full blood count needs careful interpretation and may need other contest. It is a tool used in diagnosis.

[Steph0077 in reply to Gambit62]

That’s brilliant thank you ❤️ It’s like a minefield trying to understand all this, but I’m getting educated everyday great explanation 😊

[deniseinmilden]

My Dr said I couldn't have PA "because I wasn't anaemic" - but I had very severe B12 deficiency symptoms from probably decades of a degree of deficiency, which over the last several years have mostly been reversed by daily B12 injections.

I've since had problems with iron anaemia too, alongside other vitamin and mineral deficiencies.

While the other contributors here have given you excellent answers that support my thinking on the subject, I am just wondering if your Dr is maybe like mine and just so lacking in knowledge and understanding that s/he is missing the point entirely?!

After further questioning my Dr admitted his lack of knowledge and has since been very supportive to me and has bowed to my "greater knowledge" - sending me on a useful referral and encouraging other Drs within the practice to help me. (After years of a CFS/ME dx where I couldn't get any help).

[Steph0077 in reply to deniseinmilden]

So relate to the ME/CFS diagnosis I have fibromyalgia and reynalds syndrome too (absolutely think the me/CFS and fibromyalgia are really b12 and folate deficency and raynalds syndrome iron deficiency!) I’d say it is mostly lack of understanding and knowledge, but try telling the majority of these doctors that and they will try to slap you straight back down, I am glad you have had a better experience it’s Russian roulette when it comes to doctors 😳

[Hidden in reply to Steph0077]

Reynalds join the gang, surprising amount of people here with that as well.

😜

[Steph0077 in reply to Hidden]

There’s an epidemic of us 🤔😂

[Sleepybunny]

I found some interesting articles when I searched online for "B12 folate iron anaemia".

[Steph0077]

Hi Sleepybunny how are you thank you for all your wonderful🌟 info it’s been such a help to me I am being supported by PAS and am thinking of paying the lady from b12 forum surname Whitty to help me too ❤️❤️Did you what were they? 😊

[Sleepybunny in reply to Steph0077]

Using the same search terms as I did, should show some articles that discuss competing anaemias.

Tired out hence the short reply. Keep fighting and challenging doctors if necessary and able to, it helps others as well as yourself.

NICE CKS B12 and folate deficiency link below says "MCV may be normal if there is associated iron deficiency"

cks.nice.org.uk/topics/anae...

NICE CKS Iron deficiency - Investigations section

cks.nice.org.uk/topics/anae...

[Steph0077 in reply to Sleepybunny]

That’s very helpful thank you 😊 have you heard of via path Sleepybunny? I have been in contact with them via email ,

[Sleepybunny in reply to Steph0077]

Yes, I have.

I have a feeling that one or more of the people who wrote BSH Cobalamin and Folate guidelines are associated with that company.

[Steph0077 in reply to Sleepybunny]

Yes that’s right I’m paying for full screen from them next week, 🙏

[MorningMist in reply to Steph0077]

Are you having tests at St Thomas hospital? I tried to book tests with Viapath recently and was unable to pay as they had ‘ no further testing capacity’. Tried to contact them via email and received no reply to that either. 🤔

[Spoticus in reply to MorningMist]

I have done the same, sent 2 emails but no reply?

[Steph0077 in reply to Sleepybunny]

Also I have high CRP levels (my CRP is level 29, lab value range are 0-9) which again I (think I’m right) mask anemia, you got to be an absolute expert to unravel this stuff I guess that’s why is says on bloods results for B12etc contact on call haematologist if in doubt or clinical presentation suggests defiency 🤔

[Steph0077 in reply to Sleepybunny]

Sorry I did not explain that last one very well, what I mean is if there is raised inflammation CRP or ESR) it can mask present anemias again giving false FBC readings 👍🏼❤️

[JOLLYDOLLY]

Hi, I am not sure how it works tbh, I still have B12 and pernicious anaemia, but for a very long time, I had iron anaemia as well, but only whilst I had very heavy periods, which stopped at menopausal stage, they literally just stopped! So no longer need iron and levels are fine.