Blood test

[Pearlanncollins]

Hi all, following up on my post of 2 months ago.low iron, ferritin and B 12. Have been on iron tablets and taking B12,folic acid, vitC, having a fasting blood test in the morning, what tests should my doctor be asking for. Many thanks for all your advice.

[Mary-intussuception]

How are you taking B12? Were you tested for Pernicious Anemia?

[Mary-intussuception]

2 monghs ago -

You were advised to have blood tests to check levels of Vitamin D.

You were also advised that you needed testing for Pernicious Anemia.

Also that you need full Thyroid Function blood tests FreeT3, FreeT4, T3, & T4. Also Thyroid Antibodies TPO & Tg.

You were advised that your TSH was to high and needs addressing. (Usually annual Thyroid blood test check only happens after you are stable - prior to this initial testing is every 4 - 8 weeks for at least 3 tests then every 4 - 6 monts).

Did your doctor refer you to Haematology? Did you have any iron infusions?

[bluebug]

NICE guidelines make it clear that once you start supplementing vitamin B12 there is no point having a repeat serum vitamin B12. Instead you are suppose to have a full blood count to have a look at the number and size of the cells. If pernicious anaemia is suspected then you need testing for that but there is not one test that is recognise as conclusive which is why the full blood count is used as well.

In the case of vitamin D most NHS areas have a protocol which means as an adult the smallest gap you can have between tests is 6 months. If the medical practitioner asks for a repeat test before that time then the lab will reject it. Also if you didn't measure in the severe deficient range e.g. under 25nmol/l then the medical practitioner can refuse to retest you.

Ferritin takes months to increase. Most people find it takes over 6 months to see a meaningful increase. However if you have iron deficiency anaemia as well then you should have at least your haemoglobin level - which isn't in your original test results btw, instead you have listed some other measures that indicate iron deficiency anaemia - retested in 6 to 8 weeks.

So I suggest you go to your doctor and ask for a full blood count now and do a test to attempt to confirm if you have pernicious anaemia. Also ask him/her to test your vitamin D level as you don't have a result listed in your original post, plus your TSH, Free T4 and thyroid antibodies.

[Pearlanncollins]

I am taking B12 tablets, have not been tested for pernicious Armenia,not refered to haematology, no iron infusion, I rang doctor to query treatment and tests after your comments on my last test.Receptionist just do as the Doc said take the iron tablets and have a retest in 8 weeks. Full Blood Count 8 weeks ago results were , haemaglobin concentration 120 g/L (115-165.0)

Total white blood count 9.2 10*9/L (4.0-11.0), Platelet count observation 277 10*9/L (150.0-400.0)

Haematocrit (X76tb) .37L(0.37-0.46)

Red blood cell count (426) 4.84 10*12L (3.8-5.8)

RDW 17.5% (11.0-14.8)

Mean cell volume 42A 77.0fl(80.0-100.0)

Mean cell harmaglobin level XE2pb) 24.7pg (27.0-32.0)

MPV 8.9fl

Neutrophil count 7.60 10*9/L (1.7-7.5)

Lymphocytecount 1.34 10*9/L (1.5-4.5)

Monocytes count 0.21 10*9/L(.02-08)

eosinophils count 0.01 10.9/L (0.0-0.4)

Basophils count 0.04 10*9/L (0.0-0.1)

Sorry it’s lengthy, hope someone out there can help

[Mary-intussuception in reply to Pearlanncollins]

I wouldn't be discussing this with a Receptionist - I would see GP. Receptionist can't authorise Vitamin D blood test, GP can. You need all your Nutrients levels sorted ASAP. Then you need to address your High TSH.

Did you go to Haematology? What are they doing for you?

[Mary-intussuception in reply to Mary-intussuception]

ps

What did your doctor say about your kidneys 2 months ago?

[Gambit62]

bluebug the NICE guidelines say that it isn't necessary to retest serum B12 unless there is a suspicion that the patient hasn't complied with treatment - this relates to people who are being treated with 50mcg tablets for a dietary deficiency.

Pearlanncolins, you will find a lot of information in relation to treatment and diagnosis of B12 deficiencies on the PAS forum.

I think you probably mean that you had low iron, folate and B12 (ferritin is a protein that binds to iron so is another measure for iron).

If you have a folate deficiency and low folate levels then the assumption per the BCSH guidelines is that you probably have an absorption problem and that PA is the most likely candidate. You can find these guidelines here if you are based in the UK

onlinelibrary.wiley.com/doi...

- if you are based outside the UK then you may not be able to access them. A GP based in the UK will be able to access these guidelines through the BNF. They are more complete and somewhat less confused and confusing than the NICE guidelines in relation.

Basically you should be asking your GP why you have multiple mineral and vitamin deficiencies. You could ask for the IFA test for PA but this test is prone to false negatives (40-60& of the time depending on the exact testing method) - a positive is good evidence that you have PA but a negative is not good evidence that you don't.

If you had any type of anaemia then the test should probably include a full blood count so they can see if the anaemia has gone.

Absence of macrocytosis isn't evidence that you don't have a B12 deficiency (not present in 25% of people who have a B12 deficiency.

would also go with looking at thyroid panel, folate and if you were on 50mcg tablets rather than injections at B12 - if you were on injections then serum B12 is unlikely to be of any use at this point.

[Mary-intussuception]

Hi Pearl

All the best for your tests this morning.

I have replied on your other post because that is where you put your blood tests that I was referring to.

[Pearlanncollins in reply to Mary-intussuception]

Hi All Happy New Year to all. Picked up from GP the results of blood tests taken between Christmas and New Year. Reception said all fine I would like your opinion on that. Results as follows:

Plasma fasting glucose level 5.0 mmol/L (3.5-6.0)

Haemoglobin A1c level 34mmol/mol (20.0-42.0)

Comments HbA1c below 42 mmol/mol indicates excellent glycaemic control in patientsknown to have diabetes. Check patient is not having unrecognised Hypoglycaemia. Diagnostic normal ( low risk of diabetes mellitus).

Serum ferritin level 24ng/ML (15.0-300.0).

Comments Ferritin >15 and <100ng/mL. With low Hb and MCV a normal ferritin in the presence of inflammatory changes does not exclude iron difficiency.

Serum TSH level 3.35iu/mL(0.3-5.0)

Serum free T4 level 12.1 pmo/L (7.9-16.0)

Serum free triodoththyronine level 5.6 pmol/L (3.8-6.0).

Anti Thyroid Peroxidase 30 iu/mL (0.0-9.0).

Comments Above high reference limit. Positive anti thyroid peroxidase antibody consistant with risk of autoimmune thyroid disease .Associated with increased risk of other organ specific autoimmune disease (e.g pernicious anaemia, Addison’s disease).

Do these look like fine to you, advice please. Before I go back to GP.

[Mary-intussuception in reply to Pearlanncollins]

You have Hashimoto's Autoimmune Thyroiditis, confirmed in results above.

Your TSH is still high.

Ask GP to look into iron defficiency?

Have you had Vitamin D levels tested yet?

[Mary-intussuception in reply to Mary-intussuception]

ps

(2nd reply 13/1/18)

What dose Levothyroxine are you on now, and since when?

Are you expecting a 25mcg increase in dose?

[Pearlanncollins in reply to Mary-intussuception]

Hi I am on 100micrograms of Levo, hav’nt had vit D levels tested, was waiting for advice befiore seeing Dr, have been prescribed iron, and have been taking vit c, B12 and folic acid since last blood test ( October)

[SlowDragon Administrator]

2 months ago your TSH was high and showed you needed dose increase in Levothyroxine

Has GP done this? If not SEE A DIFFERENT GP

Vitamins will never improve with high TSH. Gut function is poor because Thyroid is under medicated

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

Link about antibodies

thyroiduk.org.uk/tuk/about_...

[Pearlanncollins]

Thanks for all your comments, I added those extra tests to the blood test I had this morning (naughty me). Hav’nt seen the Doctor yet, will hopefully get a cal lin the next couple of days and I can discuss a higher dose of thyroxine and vitamins levels etc, watch this space for results!!

Many thanks all I am astounded that I was so ignorant about this condition for nearly 30 years I have put up with Doctor telling me results were fine, yet I take sleeping pills, amitrytiline for supposed fibromyalgia, which could be all due to the mistreatment I have received,.

[Pearlanncollins]

Mary,

Sorry Doctor has said nothing about my kidneys, however I have COPD and had to have a blood test about a month ago prior to a scan before seeing my respiratory consultant in Jan 2018, when I went for the scan the nurse said I had to have yet another blood test as previous one was worrying re kidneys , this is a nightmare not sure if redo consultant has informed my Doctor, will find out soon and I will definitely be asking about my kidneys.

Thankyou

[Mary-intussuception in reply to Pearlanncollins]

Pearl Ann

Please don't let this be a nightmare.

Just see GP, ask about all the comments on blood results and query your dose of Levothyroxine.

With Hashimoto's, regular Thyroid Function blood tests fluctuate - BUT you need your TSH kept down below 2. Most on this forum actually say below 1.

Sorry but I only received notification of your replies today 13 /1/18

[Pearlanncollins in reply to Mary-intussuception]

Thanks Mary ,I will make appointment with the GP, probably won’t get one for a couple of weeks .