Folate and B12 results

[Piglet1956]

Hello, Ive just had bloods done for folate and B12.

Folate 4.5 ug/L (3.0-20.0)

B12 477 ng/L (187-883)

I had the bloods done as a recent test showed I as low in Folate - I was well below range and as it looked like Im not converting T4 to T3 well I flagged this up to my GP as I was told the results are normal.

It looks to me like I should be supplementing with folate. Any comments from you helpful people out there?

[mstp]

Leading on from your question, what does it say on blood test results to indicate folate? I'm looking forward to reading responses to your question Piglet1956 because I don't really understand what it is and how it differs from iron. Sorry for muscling in on your question but this is something I've been wondering about. Your folate does look a bit low which may need topping up a bit although I'm not sure why.

[Piglet1956 in reply to mstp]

Hello mstp. Folate is Vitamin B9 and nothing to do with iron. It is important in red blood cell formation and for healthy cell growth and function apparently.

[holyshedballs]

I am in a struggle with my GP to get B12 injections.

GPs tend to look at their CCG guidance and if if says that B12 injections are not indicated if the the blood test result is above 200 they tend to not go further that that. However, the guidance goes beyond this. My CCG B12 guidance says:

• If there is strong objective evidence of B12 deficiency (macrocytic anaemia, neurological symptoms or failure to thrive) (in my case - fatigue, brain fog, puffing, glossitis) despite normal levels second line testing under specialist guidance is indicated. This guidance needs to be directed by a specialty appropriate to the patient: neurology, paediatrics, care of the elderly or haematology.

• Second line testing is complex with significant pitfalls and appropriate tests include:

• Plasma total homocysteine

This is raised in B12 deficiency but not specific becoming elevated in folate deficiency, B6 deficiency, renal disease and hypothyroidism.

In Guidelines for the diagnosis and treatment of cobalamin and folate disorders 2014 published by the British Journal of Heamatology (which the above guideline is based on)the authors state:

• In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment. (In other words don’t just rely on a blood test)

• Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues, and local reference ranges should be established.

Does patient, parent or sibling have vitiligo, hypothyroidism or pernicious anaemia? Positive family history or personal autoimmune conditions increase pre- test probability of pernicious anaemia

The National Institute for Health and Care Excellence (NICE) has a Clinical Knowledge Summary entitled Anemia - B12 and Folate Deficiency last revised in July 2020

it says:

• Diagnosis of anaemia caused by vitamin B12 or folate deficiency should be made through history, examination, and investigations, (in other words not just by the reference range)

• Cobalamin levels are not easily correlated with clinical symptoms

With regard to Folate deficiency the CKS says:

there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic. I note your Folate level is 4.5mcg/L just in the intermediate zone according to NICE.

This document does consider the interaction of B12 deficiency with other conditions. It states:

• The condition is more common in people over 60 years, and in women and in people with other autoimmune conditions, such as primary myxoedema (AKA hypothyroidism), thyrotoxicosis, Hashimoto's disease, Addison's disease and vitiligo.

There is an increasing body of evidence to show that the current lower level of the reference range is too low. People show symptoms of B12 deficiency even in higher levels, as deficiencies begin to appear in the cerebrospinal fluid below 550pmol/L. Japan has lower level of 500 pmol/L.

mthfrsupport.com.au/2015/03...

Carmel R, Agrawal Y P. Failures of Cobalamin Assays and Pernicious Anaemia. New England Journal of Medicine, 2012, 367(4): 266.

David T. Yang, Rachel J. Cook, Spurious Elevations of Vitamin B12 with Pernicious Anemia: New England Journal of Medicine; 366;18

My view is that you should supplement your Folate with preferably methylfolate.

My B12 was 335 - above 200 but below 550 pmol/L. Yours is below 550.

[Piglet1956 in reply to holyshedballs]

Thank you for your very informative reply holyshedballs. And for the journal referencesI'm coming to that conclusion myself as GP says it's normal but I think I should be at least in the middle of the range. Do you supplement with Folate and if so have you any idea what would be a good brand as too much can cause problems as well.

[holyshedballs]

I'm of the view that most hypothyroid sufferers should be nearer 1000 of Vit B12 and definitely above 550. but that is only my own view.

Re. Folate, I take a supplement of methyl folateb from Piping Rock

gb.pipingrock.com/l-methylf...