I had a range of tests this week, FBC, TSH, Liver function, Kidney function, Vit D, Potassium, and Folate. But no Active B12 or Active Iron or IF test. The MMA result has yet to come in.
Here are the results of the B12, but also the others that ( to me ) are the below range or low in the NHS reference range. All others look to be okay i.e. Liver function etc. If fact, my liver is heathly little blighter - my fear of outcome of weekend binges in Covid has reduced slightly!
Vitamin D - 29 nmol/L - RR = 25-50 - Observation noted on Blood Test - Reg Supplement needed.
B12 Serum - 512 ng/L - RR = 190 - 883 ) = bang in the middle..?
Potassium - 3.8 mmol/L - RR = 3.5 - 5.3 - Observation noted on Blood Test - Watch needed
Kidney -eGFR - 61 ml/min/1.73 - No RR given
From the FBC
- RBC - 4.0 - RR = 3.9 - 5.1
- WBC - 5.9 - RR = 3.6 - 9.2
- Haematocrit - 0. 375 - RR - 0.37 - 5.1
- Platelet Count - 237 10*9/L - RR - 140 - 400 - Observation noted on Blood Test
Other FBC blood markers look okay.
Thyroid - TSH - 0.71 miu/L - RR - 0.35 - 4.94 -
I am foxed - I was kind of hoping ( in a mad way!) to find my B12 below level - but its about in the middle. I have not take any supplements of any kind - as per kind advice from here ( Nackapan and others )
Folate is lowish but in range?? The low vit D flagged up and also low Potassium - amazes me - as I am out every day for at least 3 hours per day walking my doggy. I also have a good diet - I think, lots of stir frys, Red meat once a week, lots of chicken, lowish on carbs, fish on Fridays, cereals ( Special K) for breakfast. Does this fit to PA? mm
I feel there is something in the FBC bloods that might be relate to low blood production ( B12?) or maybe blood loss? As i have had some blood ( not lots ) in my stool intermittently, for many years. But colonscopy x 1 and Endoscopy x 2 in 2021 / 22 - showed only area 3" x 2" of stomach lining atrophy in my stomach. Does blood come from this atrophy issue? I dunno. But blood coming from somewhere. FYI - I was on high dose PPI's for 2.5 years with GERD 2018 to 2020 - another reason I thought B12 was the main culprit.
All and any comments, observations, advice very very welcome.
K 🌺
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Treesong2023
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Hi Pickle - no Ferritin - but I am following that up and thanks re the B1 - I am checking that up and B6 as well. I will request tests again - my GP nodded at the time I suggested them - but only the tests above were actually done. Dr Do-Little situ.
100g of the cereal according to that site contains 2.1mcg B12 which is not far off the RDA. Add in dairy and the regular animal foods you describe and I could see a midrange B12. But MMA could be interesting and its very hard to rule out B12 deficiency. But this would suggest to start to examine thoroughly other possible causes too, while keeping B12 in mind.
Being out in the Winter sun even every day wont get you decent Vitamin D levels in January in the UK. Probably you are mostly wrapped up too so little skin exposure. Almost everyone will need a vitamin D supplement over the winter of at least 1000IU but probably closer to 2000IU+ to keep good Vitamin D status. You need vitamin D supplements for optimal Vitamin D over the winter in these countries/climates.
Just to add the proviso : It is possible to be B12 deficient despite normal or even high blood serum results. Several on the forum have experienced this. For example, functional deficiency may be involved (which might show up in an MMA result).
Can you define the easiest way to identify "functional" B12 deficiency? I have never been able to understand if that applies to me. I had 2.5 times high end of range for MMA and homocysteine which corrected itself, almost completely, with just a few injections.
Thank you. I appreciate your time. I have tried to understand this by studying myself but the answer eludes me.
Typically an elevated MMA (Methylmalonic Acid) but with with normal or elevated serum B12 without involvement of supplementation/injections.
The elevated MMA is specific because it is caused by lack of adequate Adenosylcobalamin B12. Homocysteine is often elevated too but is less specific.
Neither are perfect markers/tests and can be in normal range despite deficiency. I dont understand why this is the case but there are papers attesting to this.
If both were raised for you, and reduced with injections, this is good evidence of b12 deficiency, whatever your serum B12 might have been.
If you had a low serum B12 result, you dont need to think about functional deficiency - a functional deficiency is where you have seemingly adequate levels of B12 but for some reason or another, it is not reaching cells and working as it should.
A low serum B12 indicates with high probability you dont have enough B12 in your system, so at that point, functional B12 deficiency is not needed to explain the problem as you just don't have enough B12 full stop.
In both cases MMA and Homocysteine will often (but not always) be raised, and reduce with treatment, indicating the deficiency is being treated.
Oh. And its possible to have low serum B12 and not be B12 deficient. If you have a genetic haptocorrin defect that means you will have less inactive B12. But you would still have an adequate amount of active B12 so in this (rare?) case, an active B12 test would be normal and could show why someone who seems deficient from serum B12 results is actually fine.
Too much information. sorry. messy business this B12.
And there is no gold standard test for B12 deficiency. Sadly.
Special K: I think that it would be difficult to expect a bowl of cereal to get you to a 500+ B12 level ! Even that appalling GP practice in Devon might baulk at offering this advice.
Problem with functional B12 deficiency: Whereas with B12 deficiency, raised MMA will reduce in bloodstream when B12 replete, in functional B12 deficiency, the introduced B12 may be unable to make the required connection with MMA - and so MMA will remain high despite B12 injections.
There is not much research regarding this condition, EiCa -
Try practical-neurology.com for Neurological Rarity: Functional vitamin B12 deficiency by Martin R Turner and Kevin Talbot (Practical Neurology 2009) in which a single case is described.
"... such patients may respond to repeated high-dose injections of B12."
This tentative advice on treatment based on the one case would not be likely to get you far in a bid for more frequent injections.
My MMA was tested because I failed to respond at all to usual NHS B12 regime after being found deficient. It was raised. It remained raised despite a revised NHS regime of 2 injections a week and finally dropped into range once I was self-injecting every other day. It took three years - but the 6th test was fine.
Despite my initial B12 result being just out of range, having raised MMA gave me a GPs diagnosis confirmed by the testing laboratory and "severe B12 deficiency" on my next doctor's certificate. It also gave me frequent NHS injections for 6 months. So yes, I think this as a diagnosis can help enormously, given the right GP.
I continue to self -inject, but now at 2 injections a week. This is sufficient to keep most symptoms under control most of the time. I am unable to reduce this frequency without problems recurring. As Nackapan quite rightly puts it, there is nothing to gain by the patient in attempting to reduce an effective treatment.
My homocysteine level was considered "normal", by the way.
Nothing was able to be found by DNA consultants looking for a genetic explanation.
Thank you Technoid. Your advice is very much appreciated. Good of you to think into my situation and comment. 🌻. Yes, ref Vit D , now that I think on it, I do cover up! And I am keeping that open mind, and I went out to Boots this very evening for some D3! Optimal "D" is a new watch word for me now! 😀.
At a glance there isn't much going on. Your Vit D is probably higher than a lot of us, but supplements are a good idea, especially in Winter.
Your potassium is tending to the lower side of normal, so it's probably genuine. If you have had any episodes of 'stomach upset' [diarrhoea] that can lower your potassium. Likewise, laxatives can do that.
Platelet count is fine. If you suffer from chronic blood loss, platelet counts tend to rise in response.
PPIs are great for leading to B12 deficiency, but you've swerved that.
In general, the most useful thing [to me] is 'has it changed from last time?'
Good luck, and stop worrying. The blood loss is coming from somewhere, and it's worth trying to track that one down.
Oh ...and taking your point re changes between tests...? The two changes from my bloods before. Over a year ago, is the drop in vit D and Potassium - both were higher. And my platelets etc higher.. with thanks 👍
Thanks Flipper. It's good to have someone look objectively at the results. I do fret. Having the fatigue, the cramps, and the burning hands, then the constant tinnitus, now the tingling and numb feet..I worry things are getting worse. Somehow. I don't think it down to GI or other types of bleeding. But you are right I have to close that aspect down. K🌻
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