HiJust a quick ask. I've noticed lymphocytes have nearly always been underange in previous blood tests.
When I had a loading dose on March the next blood test they were just back in range, ever since then they've been under and I'm doubting adequate b12 due to mch still being overange?
I foundcsome research about lower lymphocytes being a sign of b12 def.
Wondering if anyone else has lower lymphocytes?
Hi,
I don't have low levels of lymphocytes.
I have read that B12 deficiency can lead to cytopenias, lower than normal amounts of types of blood cell.
For example
Low levels of
red blood cells - anaemia
white blood cells - leukopenia
Sometimes a particular type of white blood cells is affected eg
neutrophils - neutropenia
lymphocytes - lymphocytopenia
platelets - thrombocytopenia
all types of blood cell - pancytopenia
This link about Full Blood Count might be useful.
labtestsonline.org.uk/tests...
Are any of your other blood cell results close to upper or lower limits of range?
If you have time, might be worth comparing most recent FBC results with older results and looking for things that are increasing or decreasing over time. An increase or decrease might be significant even if results are within normal range.
Might also be worth searching online for "B12 deficiency cytopenia".
I'm not medically trained.
I've just spotted your other thread from today.
Link about iron tests
labtestsonline.org.uk/tests...
NICE (National Institute of Health and Care Excellence) may have documents that would be worth you reading eg
NICE B12 deficiency guideline - published 2024
NICE CKS Anaemia - B12 and Folate deficiency - updated 2024
NICE CKS Anaemia - Iron deficiency
Patient Info website has a useful article on non anaemic iron deficiency.
I left detailed replies on these threads that might have useful info.
Help Needed! Have I got Pernicious Anaemia?
healthunlocked.com/pasoc/po...
Patient Safety
healthunlocked.com/pasoc/po...
Is this the tip of the iceberg?
healthunlocked.com/pasoc/po....
Thank you again. I’m going to do a private iron profile to see where I’m at as concerned with haemoglobin and rbc dropping and don’t want to feel any worse!
Sorry for slow reply. Many thanks Sleepybunny. I had lower neutrophils 30yrs ago when diagnosed with m.e. and at various times since, but they in range now. Looking bk on notes can see v. Low ferritin, b12 in 200’s has prob always been to blame.
The lymphocytes were below range prior to loading dose, on the blood test just after loading dose they were back into range, 1.16 (1-3), but on June, Sept & Dec, they underage agn at 0.8ish, which makes me wonder if the eod b12 helped raise them, but now not getting enough?
Over those tests, mcv went up to top of range but back to 97 this time, but MCH was 32.7 in March (27-32) and remained overange, now 33.1. I thought over 9 months this would be dropping now, partic as haemoglobin/ rbc which is now bottom of range, but was top in March.
All a bit confusing, but thank you for yr ideas,bwill follow up😀
Hi Jo5454, I do in fact have both history of B12D and low lymphocytes, so I appreciate your post. I discovered my macrocytic anemia roughly a decade ago, which appears (per self-testing and self-diagnosis) to be attributable to B12D. This was moderately well treated with B12 self-injections. Fast forward to 2020, I subsequently came down with a host of persistent symptoms following a COVID-19 infection, which I've determined to be a mild case of long COVID. Besides the macrocytic anemia, my bloodwork has been almost entirely normal (making a diagnosis exceedingly difficult) except for low levels of WBCs, including lymphocytes, monocytes, and eosinophils. My understanding is that low WBCs can either reflect an impaired immune system (e.g., in the case of immunocompromise), or paradoxically, an overactive immune system (e.g., if immune cells are excessively sequestered in an immune response). While I can't speak to your particular condition, I'd at least consider that your blood markers might be indicating non-B12-related immune or inflammatory conditions. Best wishes!
Thank you for all your info and thoughts. Sorry yre having to endure long covid on top of everything else!
Have you ever had any autoimmune tests, I’ve been looking at some on medichecks, but unsure how useful they would be.
I feel I’m not sure if I’ve ever got to the bottom of things. Seems I had lots of tonsil infections, coughs, uti s as a child, copious amounts of antibiotics as a late teenager, 20 course in near same amount of months to name a few, so I’m not surprised looking bk I crashed early twenties with m.e. Though thinking v.low ferritin , not great b12, a latex allergy & other things maybe not helping at time!
I’m finding I’m having more allergy reactions recently, along with poor health, trying to decipher what’s what, so you’re right, thinking somethings a bit amiss with general immune function, Thanks for your time,,,
Scientist, not medic.
Ranges are typically 95% limits, which means that 5% of 'normals' whatever or whoever they might be] can lie outside the range but still be normal. It's better to compare self with self, against time. If you go from B12 deficient to B12 replete, it'll still take several months for the MCH, MCV etc to return to normal. If your blood count includes RDW, that can reveal what's going on. When you're stable it approaches a minimal value. On treatment it reaches a maximum about half way through treatment, and then back down to a minimal value.
We tend to think of white blood cells and reference ranges together, but it's worth remembering that white blood cells are simply on their way to somewhere else, using the blood as a transport system.
Thank you FlipperTd…appreciate that 95%. Seems strange lymphocytes are 0.8ish all the time, except test just after loading dose, or do u think that’s normal for them to rise then please?
It’s now 9mnths from loading dose. B12 was then every 2mnthly, until I won bk monthly, which I’d had 3 months worth prior to Dec blood test.
Could u poss explain why mcv had dropped from 101, to 97, but MCH is consistently 33.1,except for prior to loading dose when 32.7 please?
My rbc is now bottom of range, but was near top in March. Ferritin is all over show, but been 35 and 58 last 2 venous tests and am confused why iron stores rose after having a period for 4 wks and presuming that’s why rbc and haemoglobin that were already lowering since b12 inj,bare now bottom of range.
Haematocrit is also bottom of range, dropping from top.
Platelets lowered too.
Know this will mean far more to you than me, and wld appreciate any light you could shed please.
I’m still feeling unwell and bit baffled😀
Hi Jo. Let's take this a bit at a time.
Don't worry about the lymphocytes. They're doing their job, and getting on with it. If you had a challenge [say, a virus] they may well go up, but then, having done their job, they'll settle again. We tend to forget that in actual fact we have our own 'range' for things, so over time you'd probably find that your lymphocytes were consistent. remember that most cells in the blood are simply using the blood vessels to go somewhere. What we think of as 'white blood cells' are generally 'tissue cells' and they're just going about their business.
Your MCV has dropped because I'm assuming that you were deficient in something [B12 or folate] and that's been replaced, so your bone marrow starts making normal=sized red cells once more.
It's interesting that you've picked up on your MCH. Before loading your MCH was raised, but now, it's crept into normal. Well done, red cells.
Periods are the one thing that gives you a great way of getting rid of iron, like it or not. Every millilitre of red cells lost = 1 mg of iron lost. As you're no doubt aware, you've lost quite a bit if it's gone on for a month. [Seriously, you need to get that looked at. I've got a background in that area that I won't share here, but trust me; a month's rather too much!] So, having had a chronic blood loss, I'd expect your Hb to fall, and with it, your RBC. Your Iron [in terms of ferritin] would go down as well, because your bone marrow is doing its best to keep on churning out more red cells to replace the ones you've lost. Interestingly, you mention Iron stores, but I suspect we're talking about ferritin here. Ferritin is good for monitoring iron status, but if anything else is going on, then ferritin is an acute phase reactant protein, so it goes up regardless. Then it comes down again.
It's worth noting that Hb and RBC reflect much the same thing, and PCV[Hct] reflects Hb too. The derived stuff, like MCH and MCHC, are simply, as I've said, 'derived'. We actually measure Hb, RBC and MCV. Then we derive Hct from [RBC x MCV]; MCH from [Hb/RBC] and MCHC from [Hb/Hct]. Keep an eye on your Hb, plus your MCV. If your MCV drops then that's typically because you're becoming iron deficient. So at that point your MCH is going down too.
Platelets are great little things, but difficult to count. If the sample taken isn't taken as well as if I'd done it, then it's likely that some of the platelets will be lost in the sampling process. Equally, if you're suffering blood loss, your platelet count goes up, and then on recovery, comes back down again. When you make more new, healthy platelets they tend to be a bit bigger, but frankly measuring the size as part of an FBC is a bit pointless because there are so many artefacts. But we do it because we can...
It's all very well for me to say 'don't panic' because all these things go on without any interference from us, but they do. So, as Joe Jones [Dad's Army] would say, 'Don't Panic!' All of these things are inter-related.
I hope this isn't too confusing!
Many thanks once again for such detailed explanations...Periods usually regular for me, though more frequent/heavier if my ferritin is lower. First time I'd had one that lasted month, saw Dr as I had a funny turn, she said just record my periods on an app, seeing as I've hit 50?
Had a nearly 3wek break, then a normal one for week, so I'm really wondering if having the monthly b12 fior 3months then was having some kind of healing effect or maybe I'm hurtling towards menopause to add to the confusing symptoms
About the mch, don't think I perhaps described that correctly, it was 32.7 in March before loading dose and ever since on last 4 rbc venous tests raused to 33 & this time 33.1?
Appreciate it takes time to go down, but I'm 9mnths since loading dose? Can I ask your thoughts on that please.
Is the mch trying to say its a b12 prob still even tho mcv has this time dropped from 101 to 97 , perhaps due to lowering of rbc & haemoglobin?
No, not confusing thanks, very nicely explained & promise I'm not panicking but I'm just trying to sort out how to stop feeling so weak & poorly & desperate to find so things to help. This has been under the guise of ME for best part of 3 decades & diddled off with it! thanks again...
Hi JoJo.
It's complicated. In your first paragraph, it's probably the other way round. Your ferritin is lower BECAUSE your period was heavier, and your bone marrow has been bashing away making more red cells to make up for the loss. My guess is that these are simply occurring at the same time. The differences in the numbers are sufficiently small that I wouldn't get excited. I'd like to see your MCV come down a bit more once the treatment is sorted, but 97 is probably quite normal for you.
Try and grin through it!
Yes, yre right, guess I was just trying to say that periods remain heavy, until I take iron for months and if i can eventually raise levels to 70-100, then they get lighter? Which I find strange as surely they'd always remain the same regardless of whether my iron us good or not? I find that confusing:)Appreciate that, but out of interest, if iron deficiency brings mcv down then how do we know whats what??
If the equation for rbc/haemoglobin,etc helps give us mch results, then why is my mch still reading the same when those 2 results have dropped fair bit...
I love a good ponder, but I struggle to sort this out in my head, lol, but I will keep a grinning! The Cheshire cat has nothing on me! Thanks again
I too have low lymphocytes and high MCV yet again. My GP recently commented it’s caused by my Crohn’s medication. Particularly the immunosuppressant component of my treatment. He has recommended that I may need the dosage be reduced as I’m more susceptible to infections more now than in the past.
It’s a suggestion to consider any other medications that may be contributing to your low lymphocytes.
As all the previous information may also be applicable to your situation.
Sorry to hear that. I don’t take any other meds aside from b12 inj and various vits, but thank you for your thoughts and hope that your results and symptoms soon improve.many thanks…
Your GP sounds to know what they're talking about!
Hi,
Just wondered if you have any gut symptoms?
Auto immune gastritis (AIG) can be associated with PA (Pernicious Anaemia).
There is some research suggesting a possible association between gut microbiota and development of auto-immune disease eg between H pylori infection and development of PA.
It is possible to get private tests in UK that look at gut biome. Don't think they're available on NHS.
Might be useful info on GUTS UK website.
They have an article on gastritis.
Were you ever checked for coeliac disease?
People with coeliac disease can get a negative result in usual tTG IgA test for coeliac if
1) they have IgA deficiency
2) they were not eating enough gluten prior to blood being tested
Coeliac UK have a good article on diagnosis including a self assessment form.
coeliac.org.uk/information-...
I found research that suggested an association between coeliac disease and low levels of lymphocytes.
Search for "coeliac lymphocytopenia" for more info.
Thanks very much for all.of that very useful.info and your time.I've had gut issues, was diagnosed with ibs many years ago, just because they couldn't really find anything else I think, after a colonoscopy. Dr said there was too much mucus on wall lining, but on reading old notes can't find mention if it.
I went on to explore more myself, found very high levels of candida in blood, saliva & private stool test-notbsurprised after the copious amounts of antibiotics over the years for persistent tonsil, sinus, uti infections tions. There was another bacteria showed up, can't remember that without looking up! Checked for parasites,etc.
A saliva test showed border gliadin so became gluten free. Nhs coeliac test negative.
A York test showed milk intolerance so became dairy free. If I try to reintroduce milk within days have raised temperature with feeling I've got an infection. Been considering a lactose test of sorts?
Requested a H pylori nhs test after b12 diagnosis, it came back as I think the ward was equivocal so had to retest, bit was then negative?
I've been reacting sometimes over last year again after eating, seems skin around my mouth turns white & face feels bit irritated but can't pinpointbanything and sm wondering if it's related to histamine, some are saying that worsens during menopause and hitb50 this year?
I've been looking into autoimmune blood tests one includes parietal cells, could that help prove gastric/Aig issues please,
I will read those links you kindly gave, many thanks...I've seen lots of biome tests advertised but unsure which to choose from.
Many thanks...
"I've been looking into autoimmune blood tests one includes parietal cells, could that help prove gastric/Aig issues please,"
NHS link about gastritis
(Mentions different types)
This thread about tests for PA and B12 deficiency might be useful.
healthunlocked.com/pasoc/po...
It mentions is a gastrin test which is sometime used to help diagnose gastritis.
Link about gastrin test
labtestsonline.org.uk/tests...
"I went on to explore more myself, found very high levels of candida in blood, saliva & private stool test"
I can relate to that...I suffered various fungal infections for years eg thrush, ringworm and dandruff. B12 deficiency can knock the immune system.
Patient Info website has some articles on candidiasis.
Just put candidiasis into search box. Some articles may have details that could be upsetting to read.
I had a cook book with recipes to help those with candida infections.
B12 Problem - Oral Contraceptive Pill - Does this sound correct
Does low b12 mean I have Pernicious Anemia ?
Starting SI without PA or B12 def diagnosis. Anyone else done this? 
Does this mean it isn't b12?
