Low B12 and Ferritin-Should I get an iron infusion?

[J1MC]

Hi, my bloods in Feb 2025 were:Serum B12 total: 249ng/L

B12 Active 64.6pmol/L

Ferritin 13 (been on and off supplements for 2 years, this was off again for 4mths)

Hb 130

Folate 4.8ug/L.

My low ferritin symptoms (mainly RLS and light headedness) have resolved after 2mths back on supplements but I have B12 symptoms including neurological.

GP hesitant as claims B12 in range, but has agreed a trial of 6 loading doses.

A private doctor and a FB group I consulted said I should have an iron infusion asap. I can't really afford it and the 1st date it's available is after the date my 5th loading dose will be given.

Do I need the infusion or can I continue with oral supplements?

Will the B12 jabs still work?

I already take cofactors including vit d with k2, folic acid 5mg, iron, B complex.

Thanks for any advice

[Gambit62 Administrator]

Whilst ferritin is generally a good indicator of iron status it doesn't tell the whole story and really you should have a full iron panel to determine if you really are iron deficient. There have been a few cases of people suffering from iron poisoning as a result of treatment based on just ferritin.

Although the range for Serum B12 is very large different individuals will sit at different points in this range. If you have other serum B12 tests that showed significantly higher levels of B12 (20%+ different) then that would indicate an absorption problem and resulting deficiency.

[J1MC in reply to Gambit62]

I've ordered a private blood test including a full iron panel which I'm hoping I can complete today. If the numbers show deficient I guess I'll have the infusion. If they show ok or in the wrong direction should I hold off on the infusion?

Thank you

[Gambit62 Administrator in reply to J1MC]

I am not a medical practitioner and this forum isn't a substitute for professional medical advise. Sorry, but I don't think I can advise you to do anything other than talk to a medical professional before having an iron infusion

[Orchard33]

My understanding is that ferritin levels are a reliable indicator of the status of your iron stores. Your ferritin level is very low indicating your iron store is very low even though you are not clinically anaemic. There is a hinterland where we may have all the symptoms of anaemia but tests may not conclusively indicate it. My ferritin level was higher than yours when I paid for a ferritin infusion and then began taking haem iron supervised by a private haematologist. My GP wouldn't even consider it. I then took haem iron in increasing doses - 20mg to 40mg to (briefly) 60mg - over a 6 month period monitored by the haematologist with NHS full iron panel blood tests. I went to a haematologist because I know iron can be toxic.

He was very relaxed about the amount of haem iron I was taking. Very much a suck it and see approach (which I appreciated) monitored by tests. I now take a maintenance dose of 20mg EOD and I will check this new protocol with him next month. Along with B12 SI EOD my life now has some semblance of normal. My guess is (I'm not medically trained) that if you don't have a ferritin infusion then recovery will take longer with just haem iron. Haem iron ( bovine spleen) can be imported from America from Three Arrows Nutra.

[J1MC in reply to Orchard33]

Thank you. I've tried the Three Arrows Nutra heme iron before, after 5mths it barely raised my levels so I searched back, my GP was annoyed I'd tried it. Did you have your iron infusion before your B12 injections started? I'm concerned the 1st five of my injections won't work properly as I won't have had the infusion yet. Im also worried about rocking the boat with my GP who said I need to wait and get my ferritin checked after the 6th dose and then we'll think of a plan.

[Orchard33 in reply to J1MC]

Your GP is thinking in terms of a plan, so that's hopeful. As for B12, I was injecting EOD for a year when I realised I'd reached a recovery ceiling. I began researching ferritin/iron and went to see the haematologist and told him I wanted a ferritin infusion. He agreed, more than anything to see what would happen. Three months later, on his instruction, I began synthetic iron, which sent my gut into contorted pain, and then I picked up the haem iron tip on this site. Began taking it and within three months began to improve. The haematogist had no objection to the haem. He was relatively open-minded. Hope that helps. GPs tend to be more bunkered.My understanding is that B12 and iron work together to produce good blood. Without either we become anaemic but there's a long and devastating run up to clinical anaemia and medical recognition.

[J1MC in reply to Orchard33]

Thanks. So did you know you were iron deficient at the beginning or it developed after the year of B12 ? Yes my GP is good for trialling the B12 and considering my ferritin. However I've been seeing him for 2yrs re: my ferritin levels and almost the same amount of time trying to convince him about my B12 levels and symptoms. He's only agreed because I sought (free) private advice from a specialist and developed neurological symptoms.

[Orchard33 in reply to J1MC]

Yes. Ferritin drops as iron is mobilized with the influx of B12. It is a good reason to have a ferritin infusion to boost your blood-making process. My haematologist agreed that that is what happens which is why he supported my having the infusion. As we rectify deficiencies are bodies are being rebooted. It takes time. I didn't know I was iron deficient. I had to put the pieces together and act. My own belief is that I'd probably been iron deficient for a long time. The B12D highlighted the connection between B12 and iron. I was learning on the hoof

[MarvelousWays]

A ferritin of 13 is very low. Ferritin is actually the best indicator of iron deficiency (unless there is inflamation when it may be falsely elevated)Ideally, for B12 injections you would want your ferritin at 50 or above. The 2 main probelms with it being this low are 1.The B12 injections may not work as well (as they need iron as part of using the B12 efeectively. )2.The B12 injections will possibly drop your ferritin level further due to using up whatever iron you have available which could then lead to further symptoms as a deficiency in it's own right.

Your results are actually quite similar to my initial results, but my ferritin was 9. I tried ferrous sulphate for a couple of months but only got it to 13, and I was so unwell. I ended up paying for a private infusion (GP wouldnt even consider it as I wasnt anaemic) and started on B12 injections at the same time. I put it off for a few months due to cost, but tbh wish I'd done sooner. It is really a disgrace that the NHS will not offer infusions in this situatino, leaving peole very unwell for months on end.

Good luck with whatever you decide.

[J1MC in reply to MarvelousWays]

Thank you. I can't start my infusion and injections at the same time, this is my concern. GP advised I have my ferritin checked after the 6th loading injection, and we'll make a plan then (but even he said unluckily to get an nhs infusion).Will the 1st five injections still have some effect ?

[Orchard33 in reply to J1MC]

Yes.

[J1MC]

So I paid for a private blood test including an iron panel (1st ever) these were the results:

Folate 2.21ug/l (down from 4.8 in feb)

Active B12 45.9pmol/L (down from 64.6 in feb)

GP not diagnosed B12 or folate deficiency but commencing B12 loading doses Saturday.

Ferritin 57ug/l (up from 13 in Feb)

Iron 16.7umol/l

UIBC 40.3umol/l

TIBC 57 umol/l

Transferrin saturation 29%

I have booked a private Iron infusion for the same day as my 5th b12 loading dose. However I'm now questioning if I hold off and just get Iron retested after 6th dose as GP suggested. (As can't really afford it)

[PlatypusProfit8077 in reply to J1MC]

My experience was that my b12 injections initially seemed to stimulate iron (ferritin) levels as mine were the highest I’ve ever had (55) when I started the B12 injections.

But a few months into EOD injections, it felt like I had plateaued with B12 symptoms (things weren’t improving anymore and I actually felt like I was going backwards) and my ferritin levels absolutely tanked. So fast that my gastroenterologist scrambled to do a capsule/pill swallow test as he was concerned about hidden bleeding with a drop that large and that fast.

That test revealed nothing but I ended up having an iron infusion which helped enormously.

[yorkshiregirl4]

Your blood tests do not have reference ranges attached which makes it more difficult for anyone to form an opinion about the results. You really must seek advice from a Haematologist before considering an iron infusion. There are a number of potential issues surrounding this treatment which need to be taken seriously. It sounds a quick/easy fix when anyone is not feeling very well but do take care. I would be extremely wary about considering an iron infusion if you have not already been fully assessed by a Consultant Haematologist.

The important blood tests prior to an iron infusion are a full iron panel, as has already been mentioned, but the main test before an iron infusion was the Transferrin Saturation Index from my Haematologist.

[alamagpa]

The PAS hosted a webinar last November with Surgeon and Professor Toby Richards presenting on iron. I think you would find this presentation relevant to your situation and helpful.