B12 etc

[Sashav]

Interpretation needed please thank you

Serum ferritin 8 (30 - 400)

Serum folate 2.1 (2.5 - 19.5)

Serum B12 101.5 (180 - 900)

Vitamin D total 22.6 (<25 severe vitamin D deficiency.)

[SeasideSusie Remembering]

Sashav Has your GP seen these results? What has he said? Are you prescribed anything?

Have you had a full blood count and iron panel done?

[Sashav in reply to SeasideSusie]

Thank you I have only ever been advised to take 800iu vitamin D for the vitamin D deficiency and nothing else, complete blood count showed

MCV 76.1 (80 - 98)

MCHC 368 (310 - 350)

Haemoglobin 116 (115 - 150)

Iron 7.2 (6.0 - 26.0)

Transferrin saturation 16 (10 - 30)

[SeasideSusie Remembering in reply to Sashav]

Sasha - OK, so your GP has confirmed that he really is totally ignorant and neglectful and should really be in a different job as it appears he has no understanding of being able to interpret test results.

Serum ferritin 8 (30 - 400)

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. You desperately need an iron supplement, preferably an immediate iron infusion so ask for one. Also ask how on earth can your GP ignore such a dire result, it is way, way under range. If you are only offered iron tablets for your ferritin level, kick and scream and shout until he gives in and gives you an iron infusion as this will have the effect of raising your ferritin level within 24-48 hours, tablets will take many, many months.

MCV 76.1 (80 - 98)

MCHC 368 (310 - 350)

Haemoglobin 116 (115 - 150)

These results suggest iron deficiency anaemia, and again I fail to understand how it could have been ignored. Speak to your GP about this and make sure he follows the guidelines for treatment:

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...

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.

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.

**

Serum folate 2.1 (2.5 - 19.5)

Serum B12 101.5 (180 - 900)

This is serious, you are both folate and B12 deficient. Check for signs of B12 deficiency here b12deficiency.info/signs-an... then post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc You are most likely going to have to be tested for Pernicious Anaemia and will need B12 injections. See what they say then speak to your GP as soon as possible. Do not start any folic acid which you may be prescribed until after other investigations are carried out. Ask your GP why he has ignored such seriously deficient results.

**

Vitamin D total 22.6 (<25 severe vitamin D deficiency.)

800iu vitamin D

As you can see you have severe Vit D deficiency and 800iu D3 will never in the reign of pig's pudding raise your level. It is hardly a maintenance dose for someone with a reasonable level.

You need loading doses so check the guidelines then speak to your GP, again asking why he has ignored the correct treatment.

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 ask that he treats you according to the guidelines and prescribes the loading doses, do not accept anything less. Once these have been completed you will need a reduced amount (not a paltry 800iu) 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/

**

As I said on your other thread, I would see a different GP if you can, get the proper treatment organised and then make a formal complaint against this GP for his sheer negligence. He wont be mistreating just you, he will be doing it to other patients as well, goodness knows how many he is keeping ill.

[shaws Administrator in reply to SeasideSusie]

How do these doctors who do not diagnose a patient with such serious deficiencies be allowed a licence to practice?

It is scandalous to say the least for the patient and extra suffering.

[SeasideSusie Remembering in reply to shaws]

shaws It is very worrying, the amount of times we read of this exact same negligence on the forum. I don't understand it, these doctors have been to university, medical school for years, got degrees, they are supposed to be intelligent yet they don't seem to be able to recognise deficiencies when results are below range. I didn't go to Uni or med school, I only got 3 GCE's about a hundred years ago (!) yet I have no problem understanding them. I just don't get where the problem lies, I really don't

I think there are a lot of doctors who would be better off in a different job where skills such as reading and maths aren't necessary!

[shaws Administrator in reply to SeasideSusie]

It is more than scandalous - it is downright negligent and they should be sued.

Maybe we could get something published about the dire straights of knowledge amongst people who are supposed to be doctors and we can definitely understand why people are so ill when they are relying on doctors who know less that us on the forum..

After all it is only basics, i.e. blood test results and ranges. Ensuring that every patient has optimal results. It is shocking.

[SeasideSusie Remembering in reply to SeasideSusie]

Sashav I don't usually check to see if members have posted on the PA forum when they've been advised to, but yours is so serious that I just have and noticed that you've not posted there. Please do so, I don't think you realise just how serious this could be.

Watch the first few minutes of the first film in this link (or watch the whole lot) and you might see why we point people in the direction of that forum, particularly when their results are as bad as yours

b12deficiency.info/films/

[shaws Administrator in reply to Sashav]

This is about B12 defiency.

healthunlocked.com/thyroidu...

[Gambit62]

Shashav - you are B12 and folate deficient as well as iron deficient.

Likely your GP is completely overlooking the possibility of B12 and folate deficiencies as they have focused on the fact that your blood work shows microcytosis - smaller red blood cells - characterisitic of iron deficiencies, rather than macrocytosis (larger rounder red blood cells) that is a classic symptom of B12 and folate deficiencies.

Please take a look at the PAS forum on HU

healthunlocked.com/pasoc

PA is one condition that will lead to a B12 deficiency but the forum also supports people who have other conditions that lead to B12 deficiency.

At the very least you need to go back to your doctor and draw their attention to the following:

- Your B12 and folate levels are very low.

- Macrocytic anaemia is only present in 25% of people with B12 deficiency when they first present - and the fact that you have an iron deficiency is going to mask any macrocytosis anyway.

- As you have multiple vitamin and mineral deficiencies the likelihood is that you have an absorption problem and this should ideally be infestigated.

- B12 deficiency is a life threatening condition. If the cause isn't dietary then you need injections of B12 to build your levels up and will probably need maintenance doses for life (unless the absorption problem is treatable)

Assuming you are UK based you could also refer them to the BCSH guidelines on diagnosis and treatment of B12 deficiencies which they can access through the BNF but can also be accessed here

onlinelibrary.wiley.com/doi...