Hi, any advice please?monthly b12 inj. But MCH bit overange, yet ferritin low at 28?

[Jo5454]

Hi,

Wondering if anyone can help,please?

I'm confused as to why a low ferritin result doesn't bring down MCH which is just over range again at 32.5 (27-32). Do you think it means I still need more b12?

I have a functional b12 def (have monthly inj)

I'm also trying to treat an iodine def (have taken drops150 for 6 months, but only has a rise from 38 to 41, so now swopped to Lugols) dr has said I can try Levo but we thought it would be good tntry to raise iodine first.

I'm not feeling well ( had a couple months of sinus/inner infections and 2 lots strong antibiotics this summer again). Am very tired, breathless, system seems to go into panic easily- particularly before/during period) foggy head, cold, 7st 4lb, etc. So requested tests for iron, thyroid etc.

Got a printout!

Ferritin 28 ug/L 23-300 I'd swopped from ferrous fumerate because of additives but been taking biglycinate, perhaps not working?

Folate has surprisingly jumped up to 13.1ug/L only supplement for couple days near inj.

B12 1699 expect that to be high.

Thyroid tsh 3.72 and FT4 11(dropped from 14)

Highlighted....

Wbc 10.3 (4-10)

Neutrophils 8.12 (2.00-7.00)

MCH 32.5 (27-32)

On the up good cholesterol3.9😀

Any ideas gratefully received please...

Jo

[Gambit62]

curious as to diagnosis of 'functional B12 deficiency' and how that arose.

If you have a problem absorbing B12 then that can affect other minerals and vitamins - notably folate and iron.

the type of anaemia caused by B12/folate deficiency is one in which red blood cells are larger and rounder than normal. Iron deficient anaemia makes your red blood cells smaller than normal. You can have both going on at the same time and one can mask the other.

Ferritin is only one iron measure and although it is usually pretty good marker of iron status it can sometimes throw up a red herring so you need to look at the whole context of the blood results.

WBC - and neutrophil is a WBC is only just out of range - may indicate a mild infection

[Jo5454 in reply to Gambit62]

Thank you gambit62. I got the functional b12 def. via St.Thomas a few years ago. Paid for an active b12 test, which was bottom of range, so they tested mma which was 700 (0-199). So this was diagnosed as a functional deficiency.

Yes, was thinking I'd better retest iron. It showed last time I needed to supplement, brain has done a blank, can't think which level was raised without checking back. Technically guess if I increase iron, then MCH mayincreasefurther?

Thanks for your help😀

[Gambit62 in reply to Jo5454]

if you have functional B12 deficiency then still having macrocytosis would suggest that you actually need to keep B12 levels higher than you are at the moment.

[Jo5454 in reply to Gambit62]

Thank you😀.It's all confusing this functional business! Is it partly that the range is set too low the nhs.

I think there's a lot of ways of being too low in b12 and suffering,with symptoms, guess I was just a lucky one that showed up on the active b12/mma test...hopefully there will soon be other tests to help those that are suffering with it but no tests available to show it.

[Gambit62 in reply to Jo5454]

the range for serum B12 test isn't the issue - the issue is that a) GPs and many other medical professionals have no real understanding of statistics so they don't understand the test b) the conditions that establish the normal range don't apply post loading shots, but, again most medical professionals don't actually know enough about B12 deficiency to realise this.

It would be impossible to establish any sort of range that would deal with functional B12 deficiency - the reasons why it occurs aren't fully understood - what seems to happen is that some people respond to high levels of B12 in their blood in a way that makes the process that allows the B12 to pass from blood to cells much less efficient - so one effective way of treating is to listen to symptoms and use those to decide on regularity of treatment. In theory you could wait until serum B12 levels had fallen in the expectation that this would reverse the reaction. However, this could be a very long wait as the same reaction seems to also affect the mechanism by which you remove excess serum B12 from the blood so it is much slower.