How is PA diagnosed?

[ThyroidObsessed]

How is PA diagnosed? How do we know if we have it??

I don’t think I have it but I do need to keep my ferritin in check due to absorption issues because of my Hashimotos…

[wedgewood]

First of all look at all the reasons for B12 deficiency .

Causes of Vitamin B12 deficiency .

Pernicious Anaemia is the most common cause of vitamin B12 deficiency . It is an autoimmune condition.Autoimmune conditions seldom come alone . The most common autoimmune “companion”of P.A. is a thyroid condition . There are over 100 autoimmune conditions

In P.A. the body turns on itself and produces antibodies which destroy the parietal cells in the stomach . These cells produce the Intrinsic Factor and stomach acid , both of which are essential to the process of absorption of vitamin B12 .

Atrophic gastritis , which thins the stomach lining causes Pernicious Anaemia .

Unfortunately the Intrinsic Factor Antibodies do not always show up in the test for P.A. ( Intrinsic Factor Antibodies test). This happens about 50% of the time in P.A. patients — Often takes several tests before they show up .. …. Often doctors do not have this knowledge , and conclude that a negative test means no Pernicious Anaemia . Symptoms must always be treated .

Pernicious Anaemia is incurable and must be treated FOR LIFE with B12 injections.The regularity required to keep symptoms at bay can vary from daily to 3 monthly .. It is not known why there is such variation in need. More research is needed . Tablets are NOT the answer.

There is definitely the genetic factor to be considered , If you have close relatives with the condition .

OTHER CAUSES

Vegan or strict vegetarian diet .B12 is only found in meat, fish, dairy products and eggs.( some food stuffs are supplemented with B12 ) eg marmite .

Certain medications e.g. Metformin .Proton Pump Inhibitors ( P.P.I.s) There are others — look them up .

Gastric surgeries Bariatric and others .eg Gastric Bypass, Sleeve Gastrectomy. B12 injections FOR LIFE required .

Infestation of fish tape worm ( different to meat tapeworm) caused by eating raw fish or insufficiently smoked fish that is eaten uncooked .

Abuse of nitrous oxide ( laughing gas) Midwives should take great care when administering nitrous oxide .

As we age , we produce less stomach acid, which can lead to B12 deficiency..

When , by elimination you assume that you have Pernicious Anaemia , you need to convince your doctor that is the case . A positive test for the Intrinsic Factor Antibodies is proof of P.A. But a negative test does NOT prove that you don’t have the condition .

Treatment with tablets , mouth and nose sprays and patches will not alleviate symptoms of Pernicious Anaemia . Tablets will raise the B12 in your blood but will not help the symptoms .

Because of lack of research, and general ignorance , without the positive IFAB test , it can be difficult to convince your GP that you have P.A.

It’s a well know fact that you often have more than one autoimmune condition . You already have one — namely Hashimoto’s. , which is the most common “ companion” to Pernicious Anaemia .— Food for thought ?

More observations which are useful to know about . ……

Excerpt from Mayo Clinic article on B12 deficiency /Pernicious Anaemia.

FREQUENTLY REPORTED MISCONCEPTIONS AND MISBELIEFS REGARDING VITAMINb12 DEFICIENCY .

DIAGNOSIS ………

You have no anaemia

You have no macrocytic anaemia

Your serum vitamin B12 level is within the reference range

Your serum vitamin B12 level is only moderately low

Your serum vitamin B12 level may be low, but your plasma level of methylmalonic acid is completely normal.

Vitamin B12 deficiency only occurs in elderly people

Vitamin B12 deficiency never occurs in children

You have a Negative Intrinsic Factor Antibodies test

TREATMENT .

Oral therapy is as good as painful injections .

You may stop treatment because your serum vitamin B12 level has normalised .

You must stop treatment because your serum vitamin B12 is elevated .

You must stop after 5 injections because vitamjnB12 can have serious adverse effects

You must stop the injections because your symptoms have worsened .

We must measure your serum vitaminB12 level after 3 injections to see if the treatment was successful.

We must stop Vitamin B12 injections now you are pregnant.

[JGBH in reply to wedgewood]

As usual an excellent explanation ! You should teach doctors…

[ThyroidObsessed in reply to wedgewood]

My serum B12 level was low until I started taking B12 supplements now it’s at the top of the range does this mean I don’t have PA?

I do not have symptoms I don’t think anyway… 😅🤔

[wedgewood in reply to ThyroidObsessed]

You would know if you had symptoms , believe me ! Sounds like you do not have P.A. Great !

[ThyroidObsessed in reply to wedgewood]

I suffer mentally really (anxiety depression)to be honest but think that’s related to being hypo and low ferritin at the moment, thanks for your help! 😊

[wedgewood in reply to ThyroidObsessed]

Anxiety is one of the many symptoms of B12 deficiency / pernicious anaemia , but also of other conditions .

[Gambit62 Administrator]

ThyroidObsessed PA is about B12 deficiency. Ferritin is a measure of iron.

Hypothyroidism can result in problems absorbing B12 and iron and other micronutrients. The concurrence of auto-immune disorders (eg Hashimotos and PA) is one mechanism, slow gut transit is another.

Ferritin is a protein that binds to iron. It isn't the whole story on iron status though it can be a good indicator - but to really know what is going on with iron needs an iron panel.

PA affects B12 absorption but can also affect other micronutrients, most commonly iron and folate.

[bookish]

Are you gluten free? Commonly gluten related disorders affect iron absorption first but also parietal cells so you will struggle with increasingly low stomach acid and intrinsic factor, affecting B12 absorption.

[ThyroidObsessed in reply to bookish]

I’m gluten free yes

[ottolinebear]

I have mild Hashimotos, and I don't appear to have PA, but I thought I did (it runs in my family) I got very low on folate and B1 which gave me hideous anxiety. Supplementing Thiamax (B1) and eating a little liver every day have done wonders for the anxiety and sleep. Everybody is different but I have MTHFR gene mutations which can make absorbing folate much harder. A lot of europeans have MTHFR mutations of this kind. (I am also carnivore to deal with cancer, which seems to be working!)

[ThyroidObsessed in reply to ottolinebear]

Thanks for your response, yes my folate is only good if I supplement with folic acid which is in the liquid B complex I take that also has a high strength of B12 in it which keeps my B12 too of the range… I too eat lots of good red meat but this doesn’t seem to raise my ferritin it seems I have to take a 210mg of ferrous fumarate to do that…