As you can see your ferritin is under range. You should ask for an iron panel, full blood count and haemoglobin test to see if you have iron deficiency anaemia.
In any event your ferritin must be increased. Ideally you need an iron infusion so ask for one, but you may only be prescribed tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.
The usual amount for low ferritin is one Ferrous Fumarate once or twice daily, and for iron deficiency anaemia it's one Ferrous Fumarate two or three times daily.
Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.
Eating liver regularly, maximum 200g a week due to it's high Vit A content, and eating lots of iron rich foods will help too apjcn.nhri.org.tw/server/in...
You are folate deficient with very low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so pop over to the Pernicious Anaemia Society forum here on Health Unlocked for further advice, quoting these results, ferritin/iron information, and signs of B12 deficiency healthunlocked.com/pasoc
If not then you need to increase your low B12 level as anything under 500 can cause neurological symptoms.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
That's good enough for me and I keep mine around 1000. Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself (5000mcg daily to start then when the bottle is finished take 1000mcg daily as a maintenance dose) along with a good B Complex to balance all the B vitamins.
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Total vitamin D 25.9 nmol/L
You have Vit D Deficiency according to the NICE Clinical Knowledge Summary. Ask your GP if he will treat you for this with loading doses as per the Summary, your local area guidelines which he may refer to should be similar.
Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.
For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."
When the loading doses are finished you will need to achieve the level recommended by the Vit D Council which is 100-150nmol/L.
If your GP insists on prescribing 800iu daily this wont be enough, so you can ask on the forum for guidance at that time.
Once you've reached the recommended level a maintenance dose will be needed which may be 2000iu daily, it's trial and error which is why it's recommended to retest once or twice a year to stay within the recommended range. You can get a private fingerprick blood spot test from City Assays vitamindtest.org.uk/index.html
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
Please let us know what your GP says and what he prescribes.
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You may wish to consider that your GP has been extremely negligent in ignoring all of these deficiencies. You should consider finding another GP and perhaps making a formal complaint about this GP.
GP says complete blood count results not clinically significant. MCV below range and MCHC above range.
I haven't seen your complete blood count results so I don't know which results he means are not significant.
However, MCV below range can indicate iron deficiency anaemia. Scroll down on this link labtestsonline.org.uk/under... until you reach the table 'Components of the FBC' and you will see
MCV Mean Corpuscular Volume - Increased with B12 and Folate deficiency, liver disease, underactive thyroid, pregnancy, alcohol excess, some bone marrow disorders; decreased with iron deficiency, longstanding inflammatory disorders and thalassaemia
Point this out to him.
Do you have the results you can post, to see if there are any others that point to iron deficiency anaemia?
This can indicate iron deficiency anaemia. Your low MCV along with your low ferritin should alert your GP to this so I don't know how he can say your results are not clinically significant.
You now know that you are Folate deficienct with very low B12 (and I see that you haven't posted on the PA forum for advice yet).
You know you are Vit D deficient.
You know your Ferritin is under range and along with your low MCV it probably means you have iron deficiency anaemia.
And your GP says no action required.
Now you have to decide if you are going to let this GP keep you ill, or whether you are going to ask for the appropriate treatment.
My advice still stands, get rid of this negligent quack and find yourself a different GP who will treat you.
That is a bit of a grey area. The things you have quote are worked out by using basic tests like haemstocritcand gaenihlobin and doing other. Alculations from them but you can take results that are just in range and end up with an out of range figure so you need to look at the results that are at the bottom of their ranges for a clue on what you need to improve more on.
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