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I noticed that your daughter's MCV, mean corpuscular volume, is elevated. It is an important marker in hematology and the diagnosis of anemia. The range signifies low = microcytic anemia (usually iron-related) and macrocytic (b-12 related). While your daughter's MCV elevation is not at the clinical level for pernicious anemia (b12), I would urge you to have her serum b12 measured.

The newest markers which are supposedly even better than serum b12 for measuring deficiency are elevated [B]homocysteine [/B]and [B]MMA [/B](Methylmalonic acid). You can find refs to these on e-medicine or web MD as new standard labs.

I do stress that the labs do not point to clinical deficiency, but may indicate low levels, which in my experience can have a profound effect on one's quality of life.

Here follows my own experience living life at the subclinical level of low iron, b-12 and thyroid stimulating hormone:

I sympathize with you and your daughter. I suffered from unexplained fatigue for years and drs all thought it was imaginary - especially since I was supposed to be a young, healthy woman. [B]I learned a hard lesson - that one need not be clinical to suffer debilitating symptoms from low iron, b12 and low thyroid[/B].

My symptoms, such as fatigue, loss or hair, dizziness, lack of focus, low blood pressure, cold all the time and more, increased over time, but I continued to fight against them believing as my drs seemed to indicate, that it was all a condition of life and that none of the symptoms were related.

It was not until 2006 when I could no longer take the significant anxiety and panic attacks which began in 1994, that I ended up on the road to recovery. It seems my subclinical hypothyroidism (looking back at records) became overt. Looking at my old records, I see now I was already in the 4.0 range in 1995, but nothing was done about it. I ended up at 6.0 tsh in 2006.

Stupidly, and with much regret, over the years I never actually examined my bloodwork results and left it to the interpretation of drs. BAD IDEA. So, it is good you are being proactive with interpreting your daughter's cbc.

I began treatment for hypothyroidism last April, the anxiety subsided and I felt a lot more clear-minded and could concentrate better, but fatigue still continued even after treatment with thyroid hormone and is very bad.

While researching on thyroid conditions, I came to see a lot of people also had iron and B12 concerns, So, I decided to be proactive with my health care and decided to investigate my iron and b12 levels.

I decided to ask my dr. for a [B]serum b12 test and it came back in the 200's[/B]. I now understand that one should be above 500 even though current lab ranges, and "old-school" drs don't necessarily see it that way. But, if you search the medical literature, there is a growing consensus that the lower limit of serum b12 should be higher than what it currently is.

I have been taking a b12 supplement for about a month, and feel a bit better, though the brain fog still persists and the fatigue following exercise is still profound.

With regard to my iron levels, I saw that I had a [B]serum ferritin of 18[/B]. From reading posts on this board, and searching the literature, there is some evidence that the level should be higher. I have seen from 30 - 70. I decided to supplement with iron - in my case ferrous sulphate 325 (65mg elemental iron). I have been doing so for a few weeks.

My advice:

1. Continue to supplement with iron with or without dr guidance . I would be conservative here and say that your daughter should supplement with the standard dose for pre-menopausal women, 18 mg/day [according to Office of Dietary Supplements NIH Clinical Center National Institutes of Health] I would however, test regularly and eventually seek out a drs supervision for this if you want to try to achieve a higher serum ferritin level in the event the conservative supplementation does not elevate it more than currently.

2. Seek further tests related to b12 as specified above and supplement if it is below 500. With b12 I have been told that there is little danger of too much as the body excretes the excess. You really do not need to do this under a drs supervision. I prefer a sublingual preparation, after researching that it is more effective than pill form.

3. Continue to research medical literature and other materials on the internet to increase your certainty about treatment choices you and your daughter will make.

4. Seek out a practice that emphasizes "integrative medicine" and will approach fatigue from a nutritional, hormonal or autoimmune standpoint.

Best of luck!

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