High B12 - more tests needed?

[AnotherEarlyRiser]

My SO has several anaemia symptoms - pallor, breathlessness, fatigue, dizziness, nausea etc. GP says the bloodwork is OK despite family history of PA. Blood tests (GP & Medichecks) so far show haemoglobin & MCH a bit below range, haematocrit & MCH low but in range. Serum B12 is consistently high (latest 872, range 197 - 771) without any vitamin B supplements. Also, she has autoimmune thyroiditis, having tested positive for TPO & anti-thyroglobulin antibodies.

Would it be worth while to do further blood tests, & if so, what? We've seen mention of intrinsic factor antibodies, methylmalonic acid & antiparietal cell antibody tests, but would any be helpful, do you think?

Especially with the high B12, we're totally confused! 😕

[Narwhal10]

Hi AnotherEarlyRiser,

Sorry to read about your Significant Other (SO). When you write anaemia, do you mean Iron Deficiency Anaemia ? Please note that there are over 200 types of anaemia. It’s a huge minefield.

Okay, to start, with the autoimmune thyroiditis. Please get a print out of that result showing positive for TPO & anti-thyroglobulin antibodies. A hard copy and start collecting information.

This is simply for the DIAGNOSTIC PROCESS. This is lengthy, requires discussions, physical examinations, tests, investigations and referrals.

The more succinct information a patient can give a GP or specialist, the better understanding they have of a Clinical Picture.

So, (not in order) :-

Gender.

Age.

Children.

Family History.

Employment History.

Social History.

Signs and Symptoms.

This is INFORMATION GATHERING.

Your GP’s brain is actually going 10 to the dozen at this stage. They are thinking, Right, it’s not the big nasties. Although, it could be this, this, this and a million other things. Let’s start with the basic tests and go from there.

Hey, presto. One autoimmune disease under Endocrinology. I have to treat that. Okay, there could be another autoimmune disease but which one ? There are over 80 autoimmune diseases. So, let’s test for coeliac disease, Pernicious Anaemia, Lupus, AntiPhospholipid Disease etc.

So, when a patient is able to give a good Medical History, Signs and Symptoms in a specific way, giving dates then the Clinician really appreciates it. When a patient keeps a Symptom and signs diary, it is really helpful. For example :-

12:02 p.m. on 1 July 2023, fainted.

2 July 2023, Sore throat, swollen glands, flu like, stayed in bed.

A GP or Primary Care Physician really struggles hearing the words, Tired All the Time. Their hearts actually sink. They think, Where do I go from here ? Autoimmune Diseases have vague symptoms.

When you point them in the right direction, their Critical thinking and Analysis of lots of information is superior. You will be working together.

Now, I know that high vitamin B12 levels can actually mean your SO could have PA/B12D. However, for the life of me, I cannot find the Evidence Based literature as I have over 140 windows open. Hopefully, others on here will help.

It is definitely worth joining the Pernicious Anaemia Society, membership starts from £10.00 a year. They can provide leaflets and information.

Hope this helps.

🐳

[Corney23uk]

Serum B12 can be high in deficiency, dependant on how much of it is inactive - my B12 was high but my active B12 was low. Autoimmune thyroiditis is closely linked to both B12 deficiency and iron deficiency and I am not an expert but some of those bloods maybe indicate iron deficiency. With the family history of PA further investigation is needed but GP's can not access all the tests but could do both sets of antibodies.

[AnotherEarlyRiser in reply to Corney23uk]

Thanks for that. I should have said, Active B12 is high too - >150, range 37.5 - 150.

[Corney23uk in reply to AnotherEarlyRiser]

I would ask the GP to get iron and ferritin checked asap - thyroiduk.org/if-you-are-hy... - if they don't respond then you may have to get them done privately and look at infusions.

[AnotherEarlyRiser in reply to Corney23uk]

Serum iron 19.6 (5.8 - 34.5), ferritin 226 (30 - 260). 🤒