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Whatever the MMA result is, and depending on how soon you get to see the gastroenterologist, I would make sure you get treated for B12 deficiency as soon as possible. However, document your test results because if you see the gastroenterologist after you start B12 therapy subsequent tests will logically show high B12 -- which may give the wrong impression that you never had low B12.

Your iron is very low though and probably the main cause of the anemia (low hemoglobin and hematocrit). That on its own is a good reason for seeing a gastroenterologist (low iron can be caused absorption problems or blood loss in the GI tract). Since you have one diagnosed autoimmune disorder (Hashimoto's), you may be prone to other autoimmune-like disorders of the GI tract such as Celiac disease or Crohn's. Wiki talks about a possible link between Celiac disease (gluten intolerance) and Hashimoto's, which would certainly fit with the low iron and B12.
Markers for B12 deficiency (including serum B12 and MMA) can be unreliable and it is hard to exclude B12 deficiency based on their results. Some labs have a high end of the reference range of 0.26 umole/L for serum MMA. So your MMA could be described as borderline too. If you doctor is pedantic she may refuse B12 therapy, but B12 therapy generally has few adverse effects and I would definitely make sure you get treated. If you don't get injections I would discuss taking 1000/2000umg B12 tablets or sublinguals.

If you have neurological symptoms that can be attributed to B12 deficiency (which is a long list, including numbness and tingling in the extremities, balance issues, cognitive/memory problems, etc etc) you should definitely be treated ASAP. The low iron and anemia will also contribute to your symptoms, but more in the way of fatigue.

Hopefully you will get treated soon (both for B12 and iron). If you have a malabsorption problem, other vitamins/nutrients like vitamin D may be low too.
It´s good you are getting treated, but continue to be aware of the possibility that some GI disorder is causing the deficiencies. Heavy cycles can be a cause of iron deficiency, and your doctor probably suspects that is the case. If you notice other symptoms or have a family history of GI disease you should discuss it with your doctor.

I am assuming you are getting oral B12 treatment (tablets). Even in people with decreased absorption of B12 (due to pernicious anemia or for some other reason), a small amount of the 1000mcg of B12 is absorbed so your B12 level should be up to, say, 600 in a month.

Taking orange juice along with the iron may help absorption. It is likely the iron deficiency and anemia will disappear with treatment, which together with the B12 should improve your symptoms a lot. But even when they do, you should keep in mind there must be an underlying reason why the low iron and B12 happened in the first place, and that the deficiencies/symptoms could return in the long term.





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