Bloods tests results

[diamondgirl9022]

I've had some private tests done. These are the results

Gastrin 12.6 ng/l (13-115)

Gastric Parietal cell abs negative

Intrinsic factor abs <1 <6 normal

MMA (serum) 37.4 ug/l <32

So I have B12 defiency, but not PA.

Any comments welcome

[Gambit62 Administrator]

The MMA result isn't really conclusive - its only just above range and B12 deficiency isn't the only thing that can result in raise MMA. in B12 deficiency it would normally be seen as significantly above normal range.

Both antibody tests are difficult to interpret but the gastrin really does suggest that you don't have PA

[Cherylclaire Forum Support]

Well, yes, MMA would be considered "raised", not "high", at that level.

My MMA was checked six times after B12 injections were started - and was always a constant 350-400 nmol/L (above the range: 0-280 nmol/L) - but all else having been ruled out (renal problems, SIBO), there were still doubts.

On the first test (from primary care), the diagnosis I was given was functional B12 deficiency. This was not just based on the raised MMA result, but my GP's suspicions because of my continuing to deteriorate after starting B12 injections for B12 deficiency, due to below-range B12 result. Her diagnosis was confirmed by the testing laboratory.

Six months of 2 B12 injections a week followed the diagnosis - I was doing very well, then suddenly got worse again.

I was sent then to Haematology - who weren't weren't so sure about the diagnosis. Which explains the next 4 tests .... all still within the same raised level, in spite of the very frequent B12 injections. In the end, the suggestion was that this was possibly "my normal".

My B12 injections were reduced, by the haematologist's report to GP, to once every 2 months. This felt like being given a frequency that had already proved inadequate in controlling symptoms. It was at this stage that I started EOD B12 injections.

I was sent for further tests, then to Neurology and then Gastroenterology, and then Adult Inherited Metabolic Diseases (DNA test). By the time I got to the Metabolics consultants, my 6th MMA test was finally comfortably within the normal range.

Which was proof that the raised MMA results I had been getting were not "my normal" at all.

Having had many tests which ruled out all else, and having successfully lowered my MMA by frequent B12 injections, I can only conclude that my GP's diagnosis was correct. I did experiment with lowering the frequency and have reduced to one injection every three days over time - but have now given up trying for further reductions. It just doesn't work for me.

As you age, the MMA normal range can rise - so don't let this situation continue until that becomes the cause given.

For those unsure about a methylmalonic acid (MMA) test and why this is used:

If a B12 deficiency is suspected, despite a normal serum B12 test result (eg symptoms indicating B12 deficiency), MMA can be used as a secondary test.

In B12 deficiency, MMA is usually raised - sometimes to quite alarmingly high levels - although only very rarely tested prior to B12 injections. (Perhaps expense rules this out as a routine test ? )

Ordinarily, MMA level would right itself very early on. During loading injections, the MMA left hanging around, building up in the bloodstream waiting for the B12 that didn't arrive, would then have made the link with the newly-injected B12 - and moved on to be useful at cell/ tissue level. In functional B12 deficiency, the serum B12 and MMA may not be able to make that connection easily, so don't move on to cell/tissue together. You can see how both could then be found to be high in serum tests yet be ineffective at later stages.

So yes, a slightly raised MMA level would not necessarily indicate anything serious especially in older patients, and a few other conditions to rule out first - but MMA should not still be raised after B12 injections have started.