Feel rubbish, all blood results "normal"


I have got the results of my latest blood test. For background information I finished a six injection over two weeks loading dose of b12 a week ago and have been on 3 iron tablets daily for a month. These are the results I just received (thanks for all the advice and support about how to make the GP give me my blood test results. The latest "treatment" resulting from these blood tests is that the three monthly b12 injection I was supposed to be having has now been cancelled. Because I don't need it as my b12 is high now. I felt rubbish before the injections, great whilst having them and for a week afterwards, now rubbish again. But the GP says it can't be the b12 as my levels are high now and if I feel poorly due to B12 deficiency I wouldn't feel poorly any more because my b12 isn't deficient any more. I have no idea what to do.

Serum folate level (42U5.) 4.2 ug/L

Serum ferritin level (XE24r) 32ug/L

Serum vitamin B12 level (XE2pf) Above range

Serum TSH level (XaELV) 1.4ml/U/L

Haemoglobin concentration (Xa96v) 125g/L

Total white blood count (XaldY) 5.5 10*9/L

Platelet count - observation (42P..) 253 10*9/L

Red blood cell count (426..) 4.54 10*12/L

Mean cell volume (42A..) 86.3fL

Haematocrit (X76tb) 0.392 L/L

Mean cell haemoglobin level (XE2pb) 27.5pg

Mean cell haemoglobin concentration 319g/L (outside reference range)

I don't know what any of this means, have just copied it direct from the blood test sheet. There are more results but not sure of they were relevant? If anyone has any advice on these numbers I'd appreciate it. Many thanks.

22 Replies

  • It would be helpful if you could add the ranges after the results. Labs differ in their machines and ranges can be different.

    To edit press the down arrow next to Follow post and select edit and it will take you into your page and you can add ranges.

  • Could you edit your post and put in all the reference ranges, please. We need them to help interpret the results.

    To Edit your post, click on the small square box with a v in it below your post, then click on Edit. Make the necessary changes, and then click on Post.

  • Dee215 Are there any reference ranges alongside the results? If so please add them to you our post, you can edit by clicking on the down arrow V below your original post, choose EDIT, make the changes, then click the green EDIT RESPONSE button.

    Your ferritin is very low, it should be half way through it's range with a minimum of 70 for thyroid hormone to work. You are on the maximum for iron tablets. Make sure you take each one with 1000mg Vit C to aid absorption and help prevent constipation, and take them 4 hours away from thyroid meds and two hours away from any other medication and supplements as iron affects their absorption.

    For your B12, pop over to the Pernicious Anaemia Society forum here on Health Unlocked for further advice healthunlocked.com/pasoc

  • I have stopped taking the iron tablets, on the advice of the nurse practitioner at the surgery. The iron tablets give me bad stomach pain. Not constipation (although they do that aswell), high up in the actual stomach, between the sternum and the navel. Cramping pain, quite severe, radiating into my back. Not heartburn, not acid rising up; pain, making my breathing shallow, keeping me awake at night. I asked the pharmacist for any suggestions to reduce it, he said I needed to be seen by the doctor. So I went into the surgery and explained, the receptionist put me on the triage list for a telephone call. That's what they do, they don't give out appointments until you have jumped through all the hoops. Anyway, I waited three hours for a phone call, finally got the nurse practitioner. I explained my symptoms, she said "Well stop taking them then. It will be in your system by now anyway." And that was it.

  • Dee215

    I explained my symptoms, she said "Well stop taking them then. It will be in your system by now anyway." And that was it.

    Oh FGS, what a load of tosh! Your level needs building up and once at the right level it needs maintaining. Ferritin is your iron store, the pantry if you like. When your body needs some, it takes the iron out of the pantry. The pantry then needs restocking.

    If you can't tolerate iron tablets, see if they will give you an iron infusion, that gets the level up within 24-48 hours.

    Otherwise, start eating liver regularly, maximum 200g per week due to the high Vit A content, plus lots of iron rich foods apjcn.nhri.org.tw/server/in... I raised my ferritin from 35 to 91 by eating liver as I couldn't tolerate iron tablets.

  • I really don't like liver, but I do eat a lot of eggs and green veg, spinach, broccoli etc. I am sure my diet is not low in iron. I definitely can't tolerate the iron tablets though, I am still suffering stomach pain and haven't had one since Monday

  • Your ferritin level is telling you that your iron stores are low and if you don't get your level up to at least 70 then thyroid hormone can't work, that includes your own as well as thyroid replacement.

    Sometimes needs must. I was a demi-veggie, only ate chicken and fish, but had to get my ferritin up so started eating liver.

    You can 'hide' liver by mincing and adding it to casserole, cottage pie, curry, bolognes, etc.

  • I don't take thyroid replacement, there is nothing wrong with my thyroid, there is nothing wrong with me at all, it is all psychological. Quoting the GP

    Guess Liver it is then :-(

  • I know you don't take thyroid replacement, I pointed out that ferritin needs to be at least 70 for any thyroid hormone to work, be it our own or replacement.

    Research central and tertiary hypothyroidism as mentoned in my post below.

  • We need the ref ranges

    Ferritin still too low

    What are results for




    Intrinsic factor

    What was the b12 at the start .?

  • There isn't anything on the GP tests about Free T3 or Free T4, or Intrinsic Factor. B12 at the start was 217pmol/L

  • OK, sorry about that, will try again.

    Original blood test first of all, before B12 and Iron tablets

    CRP 0.20 (<5.0) mg/L

    Ferritin L 17. (2 20 - 150) ug/L

    Thyroid Function TSH 1.16 (0.27 - 4.20 )mIU/L

    T4 Total 82.8 (64.5 - 142.0) nmol/L

    Free T4 14.13 (12 - 22) pmol/L

    Free T3 4.54 (3.1 - 6.8) pmol/L


    Anti-Thyroidperoxidase abs 7.6 (<34) kIU/L

    Anti-Thyroglobulin Abs 12 (<115) kU/L


    Vitamin D (25 OH) 84 (Deficient <25 nmol/L Insufficient 25 - 50)

    Vitamin B12 L 216 ( Deficient <140 pmol/L Insufficient 140 - 250)

    Serum Folate 13.30 (8.83 - 60.8) nmol/L

    This weeks blood test, after Loading dose of B12 and a month of 3 iron tablets per day

    Serum folate level 4.2ug/L (Folate deficient if <3.9ug/L)

    Serum ferritin level 32ug/L (15.0 - 150.0) Ferritin may be elevated due to inflammatory response and may not reflect iron stores

    Serum vitamin B12 Above range >2000 ng/L (197.0 - 771.0)

    Serum TSH level 1.4mlU/L (0.27 - 4.2)

    Haemoglobin concentration 125g/L (110.0 - 147.0)

    Total white blood count 5.5 10*9/L (3.5 - 9.5)

    Platelet count 253 10*9/L (150 - 400)

    Red blood cell count 4.54 10*12/L (3.75 - 5.0)

    Mean cell volume 86.3 fL (80.0 - 98.1)

    Haematocrit 0.392 L/L (0.32 - 0.43)

    Mean cell haemoglobin level 27.5pg (27.0 - 33.0)

    Mean cell haemoglobin concentration 319g/L (335.0 - 370.0) Outside reference range

    Hope this is more useful. Any advice would be really appreciated

  • Dee215

    TSH 1.16 (0.27 - 4.20 )mIU/L

    T4 Total 82.8 (64.5 - 142.0) nmol/L

    Free T4 14.13 (12 - 22) pmol/L

    Free T3 4.54 (3.1 - 6.8) pmol/L

    These results discount primary hypothyroidism, your TSH would have to be high, over range, for that, along with low FT4 and FT3. But a low/normal TSH with low FT4/FT3 can mean central or tertiary hypothyroidism where the fault lies with the pituitary or hypothalamus.


    Vitamin D (25 OH) 84

    This isn't too bad. The recommended level according to the Vit D Council is 100-150nmol/L. If you'd like to nudge it up a bit then 2000iu D3 daily would probably do it, that's a fairly common maintenance dose for a lot of people, particularly over the winter.

    If you do supplemen, there are important cofactors needed when taking D3


    D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

    D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

    Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds


    Check out the other cofactors too.


    Serum ferritin level 32ug/L (15.0 - 150.0) Ferritin may be elevated due to inflammatory response and may not reflect iron stores

    Not sure why they've included the note about elevated ferritin due to inflammatory response, when yours is very low.


    Serum vitamin B12 Above range >2000 ng/L (197.0 - 771.0)

    Serum folate level 4.2ug/L (Folate deficient if <3.9ug/L)

    As already suggested, post all your B12 information on the PA forum for further advice.


    Mean cell haemoglobin concentration 319g/L (335.0 - 370.0) Outside reference range

    You need to ask your GP about the significance of this. Why has it been mentioned and what is he going to do about it. Also mention that your Mean cell haemoglobin has barely scraped into range (by 0.5) and ask whether any of the other full blood count results are cause for concern.

    You need to research yourself to find answers, then armed with knowledge discuss with your GP. For starters, low MCHC:



    Also low MCHC and low MCH



    Most of us have had to help ourselves when doctors don't or wont if we want to feel well.

  • Thank you for your help, really appreciate it. I know I am going to have to help myself and am quite prepared to do so. xx

  • TSH has risen hence inadequate level of levothyroxine

    A month of ferrous fumerste witll not correct low ferritin needs 3 or 4 at least

    T4 and t3 should both be in balance in upper quadrant of ranges

    It takes at least 9months of full dose of levo tostart to turn around hypothyroid and even then it might be that only T3 or NDT resolves matters

  • I don't take any thyroid medication. I don't take any medication at all apart from an antidepressant. The nurse at the surgery advised me to stop taking the iron tablets as I told her they were causing me stomach pain.

  • Anti depressants knock thyroid function for six its vital u wean off them slowly

    Given your low B12 and hypo like symptoms its just as likely you actually have pernicous aneamia for which your gp should have checked Intrinsic factor

    PA masks as hypothyroid

    Go back and raise the issue and tell him NHS choices website knowleagable lot have suggested thats whats going on unless you actually have Hashimotos and Central hypothyroid where TSH does not rise

    as opposed to more common Primary Hypothyroid where TSH rises

  • I am weaning off the antidepressants myself. GP keeps increasing the dose, and giving me diazepam on top. He has just decided I am neurotic and more and more antidepressants will do the trick. He won't listen to the fact I want to come off them. I recently had a couple of seizures, during sleep. One of the side effects of the antidepressant is seizures. He said that does not apply to me as I have been taking this particular medication for years and the side effects only happen when you first start taking it. he has an answer for everything. The fact is that I am depressed because I feel poorly all the time, I have no energy to do anything I enjoy. It is not, as he says, psychological. I am sure of it

  • No its either

    Central or tertiary hypothyroid but without TSH freet4 and freet3 results i cant tell

    Or its pernicous aneamia and intrinsuc factir will confirm it

    The very last and worst thing you can take is either anti depressants or diazeoam

    Your GP is wrong wrong wrong ...take someone who knows you with you ...give them what i have said and dont take no for an answer

    After 50 years of dealing with thyroid and 5 family members with Central Hypothyroid i should know

  • B12 looks ok for now but no guarantee it won't drop as you don't know why it was low, do you? No intrinsic factor checked. Folate looks low although no range is given I don't think it's optimal. No vitamin D test this time? Don't know much about iron, MCHC below range - perhaps adminstrator will comment?

  • That was my issue with the GP, that B12 was low before and I don't know why, they won't give me any information on why or what to do about it, therefore I don't know if it will drop again and am guessing if it did before it probably will again. It's not diet related, I eat most of the foods on the list of good B12 foods, fortified cereal, eggs, green leafy veg, chicken and fish. I was taking a vitamin D supplement but stopped taking that as Vit D levels looked fine, but I will start it again in winter. Or maybe now as the weather here thinks it is November not August...

  • Well, your liver should store a few year's supply of vitamin B12 and excess should be excreted. If things are working properly then you should now have a good supply for many years to come. However, you do need to absorb some vitamin B12 every day to maintain that store so if you have something wrong with the absorption mechanism then your B12 levels will drop. I guess it could take 4 months or more? Then your doctor should check instrinsic factor or other blood tests to rule out pernicious anaemia.

    You need to check with your doc about the below range MCHC result though. Folate needs looking at too although it's in range so I don't think doc will do anything.

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