Suffering from massive tiredness,lethargy, no energy,decreased appetite,weight gain which I am unable solve despite increase exercise(find it exhausting but still trying)and diet.increase body fat %, hair loss,dry mouth,sometimes strange feeling swallowing,increased migraines and fuzzy head,total loss of concentration,(especially driving-just been caught speeding!),depression,anxiety,sensitive to light,very jumpy at sudden noises,frequently cold but also get hot flushes(just turned 50) irregular/heavy periods, dry skin on feet, joint stiffness and aches n pains, constipation and less frequent bowels, increase urinating. The list goes on!
Bloods show :
low ferritin 13.4(22-322)
High serum inorganic phosphate 1.44 (0.8-1.4)
TSH 2.19. (0.35-5.50)
fT4 9.7. (7.86-14.41).
Serum B12 168 (150-750)
Serum folate 4.4 (>4.0)
Thyroid peroxidase antibody < 1 (0.1-60)
IGA Trans AB 43aC.00.
Anti tissue Trans 0.4 (0-10)
Anti tissue Trans IgA Negative
HbA1c level IFCC standardised 36 .
Any suggestions appreciated, have appt Monday with GP.
Also just done Fob test but no results yet.
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Sampydoodle
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Look at your B12 and folate! You're deficient in both, and iron deficiency also comes hand in hand, they all work together. I cannot believe the bottom of your lab range is 150, that is outrageously low. I would suspect Pernicious Anaemia (PA) with those results, you must go here for more information:
Your GP should be treating you with B12 injections and a 5mg folic acid supplement, plus an iron supplement. Information on treatment can be found on this page of the NICE guidelines:
If you have any neuro symptoms injections should be every other day until no further improvement. He should also test you for PA by running anti-intrinsic factor and anti-parietal cell tests. If he says you're in normal range draw his attention to this alert about the unreliability of the serum B12 test:
"B12 assays may be vulnerable to interference resulting in normal values despite severe cobalamin deficiency. Where there is discordance between the clinical features of neuropathy – parasthesiae, loss of joint position sense, or megaloblastic anaemia and a “normal” B12 result, clinicians are advised to request storage of serum for further testing and are advised to treat the patient with B12 replacement therapy. Further testing may include repeat testing by an alternative B12 assay, holotranscobalamin assay, serum methylmalonicacid and measurement of intrinsic factor antibody. Treatment with B12 should not be delayed to avoid progression of neurological damage."
Also fill out this symptom checklist to bring to your doctor:
If he tries to tell you you're not B12 deficient because you don't have macrocytic anaemia, tell him he is wrong. The fact that you have a co-existing iron deficiency will bring your MCV down into the normal range. And also anaemia does not have to be present anyway, this is well documented in research.
If you are unsure about anything please join the PA Facebook page for more advice or the PAS forum, links here:
And yes your T4 is low, but nutritional deficiencies will do that to you, this might improve if you correct those deficiencies (if not, then you may need treatment for that too).
Haven't seen GP since bloods done but he left message for me to start ferrous fumate and do the FoB test. Why is this test necessary, I don't see any reference to it anywhere.?
Have appt Monday, should I suggest B12 injections and Folate myself or will the Ferrous Fumate correct the problems.??
Also don't understand why have put on so much weight (over 20lbs in less than 6 months) Is this all related and how can I lose it.find it really depressing. Will the B12 help?
Btw my first GP has been treating me for depression for over 2 years now, no improvement with Fluoxetine meds and lots of other symptoms in last 12months.
Should I also mention T4 levels. Didn't test T3.
Also additional bloods
Total white cell count. 5.3 (4.0-11.0)
Platelet count. 272. (120-400)
Haemoglobin estimation. 141 (115-160)
RBC 4.33 (3.5-5.5)
MCV 97 (82-100)
MCH 32.6 (26.0-32.6)
MCHC 337 (320-360)
Neutrophil 2.70 (2.0-6.0)
So much to take in but thanks to anyone who can help.
I'm assuming he wants it because you've got bowel symptoms, and also your iron is low so he wants to discount bleeding as being the cause of this?
Regarding Pernicious Anaemia it is very important that you have a look at the links I gave you and understand that this is an autoimmune condition in it's own right. It is when you have antibodies against the intrinsic factor in the stomach, or against the parietal cells that produce intrinsic factor. If you don't have any intrinsic factor, then you can't absorb vitamin B12 from food / in the gut. You can also suffer from B12 deficiency without having classic PA.
Taking iron will correct an iron deficiency, but it won't do anything for your B12 and folate levels. Only B12 and folate can raise those, and preferably B12 injections. It's also important to understand that the 3 things work together, and you need good levels of folate and iron to get any benefit out of a B12 injection.
Your MCV and MCH are right at the top of the range, this is an indication of macrocytosis (enlarged red blood cells) which is caused by B12 and folate deficiency. It is important for your GP to realise that these numbers would be even higher if you didn't also have an iron deficiency. Low iron actually causes microcytosis, which is red blood cells that are too small. So if you only had an iron deficiency and the other things were OK, your MCV and MCH would actually be low.
Since your GP wants you to take iron you should get him to look at these numbers again, make him see that you are also B12 and folate deficient.
I can't stress enough that B12 deficiency can cause all the symptoms you describe, and many people end up on anti-Ds when in fact this is what they have.
Please consider joining the Facebook group linked above because you will find lots of people in the same situation as you.
Did lots of reading over weekend ready for appt this morning. Felt really hopeful when set off as it's only second visit to this GP. (Previous one been treating depression for about 3yrs) and he asked for lots bloods on first appt.
Has prescribed ferrous fumarate as already mentioned.
Asked about Low Folate and B12 levels and he said they are fine and within range. Tried tell him they on low side but insisted its fine and no doctor would entertain giving me B12.
Also said that you wouldn't expect a female of five foot nothing to have maximum B12levels (I'm actually 5ft4in but no use arguing).
Also said that in few years iron won't be an issue for me as my periods will stop.
Says it may take couple months for iron to make an improvement to my condition and that I need to address the mental health issues and seek counselling to help!!
Don't think he was at all happy that I've been on Internet to seek help and says all labs have their own ranges to work in so anything online can't compare.
Feel absolutely gutted.
We have medical insurance with BUPA but need a GP referral which doesn't look likely!
Don't know what to do now other than take my pills.
I'm so sorry, but not at all surprised, that you have had this kind of reaction from your GP. This kind of ignorance is par for the course. We had this little thread going on the PA Facebook group yesterday about the stupid things that doctors have said to us, your post above would fit right in no problem.
Will you come over onto the Facebook group? There might be someone who can recommend a sympathetic Specialist near you, I can't see how your GP can object if it's a private referral.
It would be good to get some of the other tests done - Active B12, MMA, Homocysteine, IF and PC antibodies.
Ultimately you can treat yourself if all other routes fail, many have had to go down this road. But I'd make use of that private insurance cover first.
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