Guidance please. GP not helping.

[bflare]

From what I can gather given the below blood tests it appears that I am definitely B12 deficient and I have been advised that I should start B12 injections ASAP. However, my GP is adamant that I am not deficient given my numbers are apparently normal.

I am under a haematologist for hemochromatosis and due to see him on the 24th March to review the results of a recent bone marrow biopsy to hopefully rule out polycythemia vera. If i wasn't waiting for this result i would proceed with self injecting via Dr Klein however, I am a bit hesitant mainly because I am worried that the B12 may increase the Hb / Hct further plus it is not advisable to supplement with B12 if you have polycythemia vera.

I am not sure why I am deficient. I thought originally it maybe due to autoimmune gastritis but this has now been confirmed as reactive gastritis.

My Diet was extremely poor lacking much meat or vegetables which is probably why i was also folate deficient.

So, I am confused as to what to do?

Shall i wait until the 24th and discuss my concerns with my haematologist or shall i contact Dr Klein and look at self injecting? Have I got time to spare???

Recent Test Results

B12 active - 58 pmol/L (Range: 37.5 - 150)

Methylmalonic acid - Serum X 54.0 ug/L (Range: < 32)

Homocysteine is normal though at 7.4 (5.5 - 16.2 µmol)

Haemoglobin (Hb) 173 (Range: 130 - 170 g/L)

Haematocrit (Hct) 0.51 (Range: 0.40 - 0.50 L/L)

Mean Cell Volume (MCV) 99 (Range: 83 - 101 fl)

Mean Cell Haemoglobin (MCH) 33.6 (Range: 27.0 - 32.0 pg)

IFAB and peritel antibody - Negative.

[Nackapan]

I would personally wait.You are 'in range 'as an active b12 test

Wait fof your haematology appointment.

Of try snd bring it forward

[bflare in reply to Nackapan]

Thanks. Yeah I think the wise thing to do is wait as I’m hoping the bone marrow biopsy may provide further information such as macrocytosis.

[Flintfootfilly]

My active B12 at diagnosis was 62pmol/l (so very similar to yours, and supposedly within reference range). I was about to discount B12 deficiency as a possible cause, but my GP suggested a B12 serum test and that showed I was deficient.

My point is, be wary of interrupting B12 results strictly by whether they are in reference range or not. Doctors largely underdiagnose and undertreat B12 deficiency, and this pushes reference ranges down.

I know nothing about polycythemia vera but a quick Google shows it tends to be associated with high B12 levels because of a proliferation in red blood cell production. I wonder why this has been suggested when you show comparatively low B12 levels together with high MCV (which is associated with B12 deficiency).

I had marked improvements in my symptoms within a few hours of my first injection of B12, and within two weeks I had neurological improvements too, though it took over two years to really feel like the old me. My point here is that B12 is cheap and safe, and so If certainly want to try it every other day for some time tho see if it addressed symptoms.

Worth reading up on NICE guidance so you know what should be offered to you, and what further tests might be appropriate before you start on jabs

[FlipperTD]

Scientist, not medic.

It's probably wise not to change anything in the short term; don't consider supplementing until you've seen the Haematologist. Your active B12 is in range.

I think you have plenty of time to spare. Don't panic!