B12 good, Ferritin bad

Thank you Heather, that is most interesting.  So presumably my red cell count (which wasn't checked) should be improving, while my Ferritin will be slow to show a rise?  I was aware of the Vit C requirement, but when I've raised it with my GP they've brushed the question aside.  I'll stop taking the iron with my morning tea, and take it with breakfast, including some orange juice.  Most helpful!

Hello having a jab monthly sounds like heaven to me I got mine to every eight weeks by seeing a specialist privatly but I can't get it to monthly yet I feel downward spiral after 3 weeks , I am seriously thinking of moving house if I knew there was an enlightened GP somewhere 

 

Here is blood result info:-

MCV:

High MCV = B12/Folate Deficiency

Low MCV = Iron deficiency

An elevated MCV level is what is usually used to confirm B12 or folate deficiency, when the tests for these were low. A low MCV would be used to confirm iron anaemia in a person with a low ferritin level. However, if the patient has low B12/folate and low iron then the effect on the MCV level will be cancelled out - the B12/folate will elevate it, but the coexisting iron deficiency will lower it - leaving you with a false normal result.

Now look at the MCH, MCHC, Hb and HCT levels:

High MCH - B12 Deficiency, thyroidism

High MCHC - B12 or Folate deficiency

High Hg or HCT - Living at high altitude, smoking, dehydration

Low MCH - Iron anaemia

Low MCHC - Iron anaemia, persistent blood loss

Low Hg - Iron anaemia, Vitamin deficiency, hypothyroidism, persistent blood loss

Low HCT - Anaemia in general (iron, B12 folate etc.)

These are not the only reasons why these levels can be out of range but they are the ones which concern us most when trying to interpret them in relation to B12 Deficiency.

My last detailed tests in November 2014 show:

MCV 88.5

MCH 30.1

MCHC 340

B12 544

Folate 12.8

and all other readings were within norms.

But my serum Ferritin hovers around 22 - 24, close to the low end of the scale, regardless of supplements.  This suggests blood loss, although my periods stopped 6 months ago and I've no gastric symptoms.

My B12 has since increased to the high 800s due to monthly jabs.

A gastroscopy came back clean, but I've not had the endo.  Do you think there is any need, or is the current low Ferritin just part of the adjustment to higher B12 levels?

I have a very busy and active life for 58, but completely crashed just a couple of days before the last jab.  Suspecting low ferritin, I changed to ferrous fumerate and got terrible gut cramps, so am now on ferrous sulphate which seems less brutal.  I'd really like to see higher levels.  I'll take up the Vit C suggestion.

 

hi bluemaran. well done on getting the monthly jabs - not an easy task i'd imagine. persistence pays off? with your low ferritin, i'm wondering if you've had any test done for 'occult blood' in your stool?

Caitlin

It crossed my mind.  In fact, I'm slightly puzzled that it wasn't suggested long ago.  Did I see something on the TV recently about kits you can buy over the counter?

i'm sure there are lots of private labs that do the 'over-the-counter' equivalent. however, it might be worth suggesting it to the GP. it's cheaper for the practice than an endoscopy and a lot less invasive (traumatic) for u.

Caitlin

Do you have Eosinphil and basophil results?

I quite agree!

Yes, I do:

Eosinophil:

Feb 2013 0.1

Mar 2014 0.2

Nov 2014 0.1

Basophil:

Feb 2013 0.1

Mar 2014 0.1

Nov 2015 0.0*    

I think there may be some more recent white cell results on file at my GPs, taken about 6 weeks ago, and described as "normal", but I'll ask for the actual figures. 

The Nov 2014 Basophil result triggered a note to repeat the test at 6 weeks, but no recall was made.  By chance, I asked the jab nurse for a B12/Ferritin test in February to monitor my response, but when I rang for the results I was puzzled to find someone had changed it to a white cell test.  This was dismissed as a "clerical cock-up" at the time, and I was re-tested for B12/Ferritin last week.  However I am beginning to see that it's the white cell result that they were after, because it might have revealed a cause for concern. 

A little more openess from my GP's practice wouldn't go amiss.   I find myself having to become my own "physician". It takes 3 weeks+ to get any appointment to ask a simple question.  Meanwhile, I have to play the detective with them over test results, simply for the sake of efficiency.   It makes both parties tetchy.  Ask for any technical details and their hostility and paranoid suspicion about my "motives" goes off the clock.  I just want to be allowed to understand my own health properly, so I can mind it and stay well, without getting under the over-stretched NHS's feet.  This appears to be interpreted as an attack on their professional reputation, so simple enquiries become a minefield.

Rant over. 

Incidentally, I still have occasional bouts of exhaustion, "fogginess", short temper, bleeding gums, sore tongue, and numb hands, in spite of my high B12. To me, this suggests anaemia is still a problem.  I also have virtually no sense of taste - everything is metallic.  Weird.

hi again bluemaran. whilst on the subject of erm.....'stools', it might be worth having a full stool analysis (parasites/giardias etc) done as well as the occult blood just to ensure there's no 'baddies' in situe stealing your nutrients. think you usually need to have 3 'negatives' to be considered clear. however, the first or 2nd one may show up something.

Caitlin

I've read about this too, but it's definitely right at the "bottom" (no pun intended) of my list for possible causes.  Working all my life outdoors around animals I WILL have been exposed.  But I must also have accidentally absorbed enough anti-parasitics and veterinary pharmaceuticals to stock a vet's cupboard!  The advantage of exposure to "muck" and fresh air is raised immunity to almost everything, something the over-sanitised younger generation really need to address.  With antibiotic resistance climbing up the league of potential threats to humanity, healthy exposure to simple dirt could become very important.  Anyone for a few hours mucking out at my place? : )

Hi  Heather,

Right, white cell results from 6th March this year read:

Neutro 1.9

Lympho 1.4

Mono 0.3

Eosino 0.1

Baso 0.0

These all fall within the given normal ranges.  But reviewing my notes, it's the Neutrophil reading on 1.4 (norm 1.9-7.5) in November last year that triggered the most concern. 

My Neutrophil results have been falling steadily:

3.1 in Feb 2013

2.2 in March 2014

1.4 in November 2014

1.9 in March 2015

What might this flag up?

 

Levels above low range of Eosinphil and basophil along with some increases in liver function can point toward parasite infection. Yours seem to be ok on this score 😉

Well, it's nice to know that the enemy is not "within"!  : )

Does a falling Neutrophil reading, against a background of rising B12 reading, and consequential low/static Ferritin result look logical to you?  Everything impacts on everything else, which is a little brain-taxing.  From the little bit of research I've done, it looks as though - if I can get my Ferritin back up now - the Neutrophil reading might improve too.

Neutrophil increase could be for a number of reasons. Medicating iron or even the changes to your b12 levels can cause a little stress on your body while it adjusts. Inflammation could be another cause. Hopefully once your levels normalise then your neutrophil will follow suit.

Hi Heather.  It was the steady decline in Neutrophil readings, from 3.1 to 1.4 in 18 months,  that worried me.  I went below normal in November, and have now made a very small improvement to just baseline 1.9.  It evidently worried my doctor, too.  I'll be looking for another test in 3 months (I might as well check iron readings at the same time).  I also wondered if a positive change in my personal life in December (I am now blissfully single) might have been contributing to the high-ish level of 3.1 18 months ago, followed by a steady fall while my ferritin has been low, and the recent pick-up to basline normal of 1.9 last week.  Stress caused by "destructive" relationships goes underrated as a cause of poor health, eh?  : )