B12 Deficiency Symptoms - is this possible with 'normal' levels?

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Hi guys, I'm just curious - is it possible to still have a B12 deficiency/many of the symptoms that go along with this, but still have what is considered a normal Active B12 level?

I had a whole raft of blood tests done for B12 deficiency and an autoimmune disorder but all came back as normal. Many were near the lower end but still, fairly normal. I'm seeing a private GP, as my own one has been nearly useless and he is adamant that my symptoms show the above and is keen to treat with B12 injections, folate and vit D despite the results being relatively normal.

Is this possible?

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  • Posted

    Sorry I cannot answer this -I am the opposite have high B12 levels in blood but have a B12 deficiency due to surgery many years ago. It may depend on what your other symptoms are that may suggest your private GP is looking at a B12 deficiency. You could try an injection and folate to see if they stop your symptoms. 
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  • Posted

    Do you know what the level of active B12 was?

    The limits for active B12 are about 1/5 of the levels of serum B12 as it just measures B12 that is bound to the protein that allows it to pass from blood to cells - which tends to be about 1/5 of the total B12 in your blood. 25 is about the bottom of the range for active B12 

    You could always ask for an MMA test. Methylmalonic acid is a chemical used up in one of the cellular reactions mediated by B12. If there's not enough B12 in the cell then MMA levels will rise. If they're not high then it means your cellular levels of B12 are OK. High levels of plasma MMA (>0.75umol/L0 almost invariably indicate cobamalin deficiency

    The uMMA test measures the amount of MMA in the urine or blood.  Elevated levels of MMA indicate B12 deficiency.  MMA is 40 times more concentrated in the urine than the blood, and the urinary MMA  (uMMA) is the preferred test over the serum MMA.

    The new BCSH guidelines say: “Plasma tHcy and/or plasma MMA, depending on availability, may be considered as supplementary tests to determine biochemical cobamalin deficiency in the presence of clinical suspicion of deficiency but an indeterminate serum cobamalin level”.

    https://www.southtees.nhs.uk/services/pathology/tests/methylmalonic-acid-plasma/

    I am not a medically trained person but I've had Pernicious Anaemia (a form of B12 deficiency) for more than 46 years.

    I wish you well.

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