b12 iron relationship?

[MuppDog]

Hi friends…I was diagnosed with a b12 deficiency in June, which is thankfully improving with injections (I had horrible neuro symptoms). I had my iron tested twice over the summer, both well in the good range (over 100). However, this week I had an iron panel showing my iron is 40 (literally the bottom of the range), ferritin is 14 (low bound of the range is 16) and % sat is 10 (low bound is 15). The iron binding was well within range.

I have negative IFAB, negative Anti-parietal, and serum gastrim also very normal - and thus not “classic” PA. I also do not have SIBO, and my h pylori antibody also negative. No crohns, no celiac, no IBD (all tested for).

Can someone explain why my iron has now dropped so low? Is it because my body is using more as it recovers from the b12? I don’t fully understand the iron/b12 relationship.

Much appreciated!!

[Asselchen]

I always was deficient in iron too, due to heavy periods, but I was able to get my ferritin level up with iron pills. Since I need to inject b12 daily the iron pills stopped working. I suppose iron is used up super quickly now. I'm looking for a doctor to get infusions now.

[Orchard33]

I now think, having only started taking supplementary ferritin in the last few months (diagnosed December 2021) that I do need extra iron to help produce healthy red blood cells. It's hard to quantify whether it's helping. But it is part of the mix of supplements and EOD SIs that are producing an overall upward trajectory.Having said that, my healing path is rather like the FTSE 100 graph, an upward trajectory over years but with severe dips in the short term.

I was very struck during the covid pandemic of the use of the term 'underlying health condition' for people who suffered badly from the disease. I'm slowly accepting that that is me. I have an underlying health condition that makes me more vulnerable to any other health event. That and age. Hey ho!

[blackmarker in reply to Orchard33]

I would suggest to do stomach endoscopy and take some samples for biopsy to see if atrophic gastritis is present. Have you done your thyroid profile, especially anti-TPO, if positive that would suggest autoimmune gastritis.

[Orchard33 in reply to blackmarker]

Yes. Both.

[Sleepybunny]

Hi,

"No crohns, no celiac, no IBD (all tested for)."

What tests did you have for coeliac disease (celiac in US)?

It's possible for a person with coeliac disease to get a negative result in tTG IgA test (usual test for coeliac) if

1) they have IgA deficiency

IgA is an immunoglobulin.

Did you have a Total IgA test?

2) they were not eating enough gluten prior to being tested.

More info about diagnosis on Coeliac UK website

coeliac.org.uk/information-...

There are many possible causes of B12 deficiency

Risk Factors for PA and B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

Next link about causes is from a Dutch B12 website

b12-institute.nl/en/causes-...

Thread about tests for PA and B12 deficiency

healthunlocked.com/pasoc/po...

I'm not medically trained.

[MuppDog in reply to Sleepybunny]

I had a few differed tests for celiac, and a calprotectin test as well (for inflammation). I will, however, revisit with my gastro next week

[FlipperTD]

Scientist, not medic.

Assuming you've got problems with B12 absorption then iron may well be a problem too. If your stomach isn't producing hydrochloric acid then absorbing iron will be a challenge.

Keep an eye on your FBC values, typically MCV and MCH, as well as your Hb. If they stay in the reference range then you're probably coping. I've seen patients [and colleagues] with very, very low ferritin levels but still maintaining their Hb, MCV and MCH. Everyone's different.

Unsupervised, un-monitored Iron replacement therapy is best avoided, because excess iron is worse than deficiency. [IMHO]!

[MuppDog in reply to FlipperTD]

Absolutely! I am going to check in with my hematologist this week. I have been suspecting that I have low HCL for a while, but the gastro sort of dismissed it. Even if I don’t have a definable stomach problem, I have been dealing with very high levels of stress for several years (work, aging parents, losing a pet, a pandemic, etc), and I know that stress can lead to low stomach acid…even if the gastro thinks it is far-fetched.