I’ve put a very potted history in my bio. My question is- of the recent blood results, which would be the most useful to post seeking guidance from you knowledgable folk? I seem to have had everything and chips done by GP- not complaining.- and started a course of B12 injections. But from the results so far the only action is to repeat ESR and CRP in 4 weeks. I am wondering whether (as with thyroid tests) what may be ‘in range’ when viewed within the bigger picture may indicate an issue. For example I do have low but in range ferritin despite taking ferrous sulphate on alternate days. Which of the results are the ‘indicators’ I need to be checking. I’m convinced there is more going on in my body than just Hashimotos. I best describe it as trying to wade through treacle whilst wearing a suit of armour. This is along with chronic pain, burning/tingling hands and feet, hair loss, tinnitus, joint pain and bruising to name a few.
Many thanks in advance
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Daisywhoopsa
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As you have mentioned tingling, burning and tinnitus, I would expect your GP to put you on the second pattern, for those with "neurological impairment"
NICE CKS (Clinical Knowledge Summary) B12 deficiency and Folate 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
CCGs (Clinical Commissioning Groups) in England were replaced by ICBs (Integrated Care Boards) on July 1st 2022. It's likely that ICBs will take on the clinical guidelines of the CCGs they replaced.
Each ICB/Health Board is likely to have its own local guidelines on treatment/diagnosis of B12 deficiency. Worth tracking down the local guidelines for your area of UK and comparing the info in them with BNF, BSH and NICE CKS links.
To find local guidelines
1) Try a search of forum posts using term "Local guidelines"
2) Try an internet search using "name of ICB/CCG/Health Board B12 deficiency guidelines"
3) Submit a FOI (Freedom Of Information) request to ICB/Health Board asking for a copy of or a link to 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.
Thank you so much for the info- guess what I’m doing this afternoon? I recognise some of those links from the limited research I’ve done recently but no doubt there will be much more info from the links you’ve provided. I’m currently not working so have limited funds for supplements and/or subscriptions but thank you for the advice. No doubt I will be back with more questions.
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.
Welcome here. Sorry to read you are unwell and I know Sleepybunny has given you quite a lot of information to read so I’m not going to add to it when you’re wading through treacle. (Fatigue is hideous).
I cannot find the direct link but have know for 2 years that we need really good ferritin levels when receiving B12 injections. I’m talking 60 - 80 micrograms/L.
That’s why it’s always good to have a print out of our blood results. Plus keeping a symptoms diary.
ferritin is a secondary indicator of iron status and whilst it is generally a good one there have been instances where medics have acted on ferritin alone and an iron overdose has been the result.
If you have had a full blood count and nothing in that indicated iron deficiency I would go with that rather than obsessing about the ferritin figure.
Unfortunately the symptoms you mention could be down to a number of conditions - including thyroid and B12 deficiency. Recovering from B12 deficiency can take a while - and if you had signs of macrocytosis in your blood work that will take a month to clear - and macrocytosis affects the efficiency with which your cells carry oxygen from the lungs.
It is possible to have a mix of microcytosis and macrocytosis going on - which should result in an elevated RDW without any other explanation (eg a deficiency of iron, folate or B12 that was being treated at the time blood was drawn).
The ESR is a general screen, about as specific as taking your temperature. If raised, soemthing's wrong. If normal, doesn't tell you much. The same goes for CRP. ESR was introduced when we were trying to find a test that would indicate pregnancy. In pregnancy, ESR goes up; unfortunately, it goes up in just about everything else too. ESR goes up steadily, CRP goes up quickly. Typically in any inflammatory condition. Eventually, the ESR resolves when convalescing.
Many blood tests take very little time but use some elegant technology. The ESR takes an hour, and needs nothing other than to be left alone, to stand vertically, without being moved. It has been automated, but the manual method still works.
I realise I've rambled off topic, but it wouldn't be the first time!
Hi. You're in danger of me rambling off into the sunset, talking about what causes the ESR to be raised, but we can leave that for another day. But let's say it's all about the formation of 'rouleaux'.
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