Feedback on ferritin etc

[Artlover93]

FERRITIN 11 (15 - 150)

MCV 78.2 (80 - 98)

MCHC 386 (310 - 350)

MCH 28.1 (28 - 32)

IRON 5.6 (6.0 - 26.0)

TRANSFERRIN SATURATION 12 (10 - 30)

FOLATE 2.0 (2.5 - 19.5)

VITAMIN B12 183 (190 - 900)

VITAMIN D TOTAL 24.4 (<25 SEVERE DEFICIENCY)

Supplementing with 800iu vitamin D3 and 5mg folic acid

Thanks

[SeasideSusie Remembering]

Artlover93 In your other thread you have said that you "supplement folate and ferritin etc.". Is there anything else besides your D3 and folic acid you are supplementing with?

FERRITIN 11 (15 - 150)

MCV 78.2 (80 - 98)

MCHC 386 (310 - 350)

MCH 28.1 (28 - 32)

IRON 5.6 (6.0 - 26.0)

TRANSFERRIN SATURATION 12 (10 - 30)

Below range ferritin and MCV/MCHC suggest iron deficiency anaemia. Has this been confirmed? If so what is your treatment?

If not, make an urgent appointment with your GP to discuss NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines)

cks.nice.org.uk/anaemia-iro...

Have a read through but this is the treatment:

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

Ensure you get the correct treatment - 3 x ferrous fumarate daily for iron deficiency anaemia - and 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.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

Due to your below range ferritin level, 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.

**

FOLATE 2.0 (2.5 - 19.5)

VITAMIN B12 183 (190 - 900)

Folate deficient and B12 deficient. Has your B12 deficiency been ignored? Do you have any signs of B12 deficiency b12deficiency.info/signs-an...

Take these results, your ferritin/iron results, plus any signs of B12 deficiency and post them on the Pernicious Anaemia Society forum then discuss what they say as a matter of urgency with your GP healthunlocked.com/pasoc

You will probably need testing for Pernicious Anaemia so I suggest you stop taking your folic acid for now as this can mask signs of B12 deficiency and may skew results (PA forum will advise). You may need B12 injections.

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."

**

VITAMIN D TOTAL 24.4 (<25 SEVERE DEFICIENCY)

Severe Vit D deficiency. Well, 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

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)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and demand that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (not the paltry 800iu your GP will prescribe) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

**

I think it might be best, considering this GP's apparent negligence, that you see a different GP, sort out the proper treatment then maybe consider if you want to make a complaint against this GP for ignoring these deficiencies.

[Artlover93 in reply to SeasideSusie]

Sorry I take 5mg folic acid and ferrous fumarate once a day and iron deficiency has been confirmed

[SeasideSusie Remembering in reply to Artlover93]

You need to post on the Pernicious Anaemia Society forum. I believe they will advise stopping the folic acid whilst further investigations go on for possible Pernicious Anaemia.

You might want to take a look at the first film on this link (not necessarily watch all of it) to see what B12 deficiency can do and why it's important to sort it out b12deficiency.info/films/

I have given the guidelines above for the treatment for iron deficiency anaemia, you need to make sure your GP gives you the appropriate treatment.

[Gambit62]

there is a very small risk of precipitating nerve damage if high dose folate levels are used in the presence of a vitamin B12 deficiency but it's quite sudden and would have happened by now and think the only reported cases have happened where the B12 deficiency was much more severe.

Please do take a look at the PAS forum

healthunlocked.com/pasoc

You have multiple vitamin and mineral deficiencies which suggests an absorption problem - would be good if you could also get your GP to explore this - causes would include PA, Coeliacs, crohn's and drug interactions (eg PPIs treating eg acid reflux)