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I am new to this board and trying to find answers. I have many symptoms of anemia and have had blood work done that proves I am anemic. Here are some of my levels:

Ferritin: 2
Hemoglobin: 9.5 (Low)
Hematocrit: 30.5 (Low)
MCV: 68 (Low)
MCH: 21.2 (Low)
MCHC: 31.2 (Low)
RDW: 17.7 (High)

I also had high Thyroid Antibodies (but with normal thyroid levels otherwise), and borderline ANA (autoimmune antibodies) and low Vit. D.

I have extremely heavy periods (fibroids) and am in the process of getting my hormone levels checked.

Here is my question:

I have two relatives with pernicious anemia (my grandfather and uncle) as well as various autoimmune diseases in my family (MS, myasthenia gravis, celiac, Hashimoto's).

My doctor started me on Vit. D, B12 1000 mcg., folate 1000 mcg., and ferrous sulfate 125 mg. twice a day. I wanted a baseline blood test on my B12 levels before I started on the B12 and folate, but she says just start on it and we will test my levels after a month and see if my hemoglobin and ferritin levels come up.

I read that taking folate will mask Pernicious Anemia and am worried that this will happen with me as I already have some problems associated with this such as numb arms and hands, eyelid that twitches 24 hours a day, swollen eyelids, brain fog, tiredness, shortness of breath, heart palpitations, heart murmur, etc.

Should I just take the iron supplements and B12 and not take the folic acid until after I get the additional blood work completed?
Hi HKK,

First of all welcome to the boards. Your question is a very interesting one, but I want to address one thing before I begin. In today's world with information being available at anyone's fingertips who has the internet, a lot of medical information goes around to people and unfortunately in many ways it's out of context. As a result, tension arises between doctor and patient mostly because doctors are horrible communicators--even if they are right about something! I'm not totally siding with your doctor, but if you look at the values you gave for your bloodwork, and you have some medical training, it's easy to see that vitamin B12 deficiency is not your problem.

Whenever someone has anemia, it is important to ask WHY. In your case, your anemia is almost certainly due to iron deficiency. Again, however, the question has to be asked, WHY do you have iron deficiency anemia? As a young woman with heavy periods, that is a good explanation to the underlying cause. Iron deficiency anemia is characterized, yes, by anemia, and evidence of low iron stores (i.e. a ferritin of <18), but there are other markers in your bloodwork which highly suggest longstanding iron deficiency. Your MCV or mean corpuscular volume (i.e. the average size of your red blood cells) is very low. Normal is between 79-97. Because your RBCs don't have enough iron to make hemoglobin, they end up becoming smaller. Additionally, your RDW is wide. What that means is that there is great variability between the sizes of your red blood cells. This suggests that rather than there being a DNA problem with your cells (i.e. in something like thalassemia) there is more of a problem in the blood getting iron. Some cells are able to get more iron than others and are thus bigger.

So what the heck does this have to do with Vitamin B12? Well, in vitamin B12 deficiency your MCV is normally LARGE. On average, people with Vitamin B12 deficiency have MCVs which are over 100. If you had BOTH iron deficiency and Vitamin B12 deficiency, your MCV would probably be in the "normal" range because the small RBC effect of the iron deficiency would "cancel out" the large RBC effect of Vit B12 deficiency.

Now on to your symptoms. I understand that your family has pernicious anemia, and yes, this does somewhat increase your risk for getting it; however, I would stop short of saying anything else. One common misconception by patients is that, if they list their symptoms to a doctor, s/he will be able to immediately tell you what disease you have. There is the idea of "specificity" of symptoms. To elucidate further, if someone walks in to the doctor's office complaining of a cough productive of green phlegm and a fever, well, that is pretty SPECIFIC for pneumonia. HOWEVER, most symptoms patients experience are very NON-specific. "Numb hands", "brain fog", "palpitations" (etc.) together do not point towards any one diagnosis at all. They are all very non-specific. This is why when people go to the doctor, it seems like the doctor isn't listening. What the patient thinks are important symptoms are rarely helpful in making a diagnosis. The doctor, however, DOES know the important symptoms, so s/he will often brush the patient's complaints off and ask specific questions. Unfortuantely, if the doctor is not a good communicator, this leads to tension.

WHOOOOOOO, that was a long-winded post, but aside from my explanation of anemia, does my explanation of specific vs. non-specific symptoms make sense?
The reason they give you folate with iron is because it helps you to absorb the iron. I do have Hashimoto's and your blood labs are very indicative of Hashimoto's. Ferritin of 2 is terrible and if you aren't having horrible symptoms, I would be surprised. I was at 18 and have never been more miserable in my life. I was prescribed chromagen forte and four months later I am at 53 so much better. My vitamin D was at 11.8 and now after 2,000 iu per day my Vit D levels are still low but improved to 18. So it does sounds as if you have Hashimoto's which alone will mess with you and put you up and down and all over the place until your thyroid finally burns out. So tell your doc about your concerns with the pernicious anemia. I do believe in pernicious anemia the blood cells do look different under the microscope. However with iron deficiency anemia and hashimoto's your blood cells still may not look different, so ask your doctor that as well.
If you have a doctor who doesn't like questions or request, you simply have a bad doctor. Any time an ego gets in the way, the person is not in the field for the right reasons, so move on if your doctor is that way.
[QUOTE=herekittykitty;3873613]I am new to this board and trying to find answers. I have many symptoms of anemia and have had blood work done that proves I am anemic. Here are some of my levels:

Ferritin: 2
Hemoglobin: 9.5 (Low)
Hematocrit: 30.5 (Low)
MCV: 68 (Low)
MCH: 21.2 (Low)
MCHC: 31.2 (Low)
RDW: 17.7 (High)

I also had high Thyroid Antibodies (but with normal thyroid levels otherwise), and borderline ANA (autoimmune antibodies) and low Vit. D.

I have extremely heavy periods (fibroids) and am in the process of getting my hormone levels checked.

Here is my question:

I have two relatives with pernicious anemia (my grandfather and uncle) as well as various autoimmune diseases in my family (MS, myasthenia gravis, celiac, Hashimoto's).

My doctor started me on Vit. D, B12 1000 mcg., folate 1000 mcg., and ferrous sulfate 125 mg. twice a day. I wanted a baseline blood test on my B12 levels before I started on the B12 and folate, but she says just start on it and we will test my levels after a month and see if my hemoglobin and ferritin levels come up.

I read that taking folate will mask Pernicious Anemia and am worried that this will happen with me as I already have some problems associated with this such as numb arms and hands, eyelid that twitches 24 hours a day, swollen eyelids, brain fog, tiredness, shortness of breath, heart palpitations, heart murmur, etc.

Should I just take the iron supplements and B12 and not take the folic acid until after I get the additional blood work completed?[/QUOTE]

[B]Hello :wave: herekittykitty--I love your name, it makes me want to start calling cats:D LOL!

From your labs they do point to iron deficiency anemia, why, is what you want to find out. You are considered moderately anemic almost, mild. Your MCV is not ~just low~ but severely low at 68. And....your are very iron deficient at a 2 ferritin which is considered no iron (under 10), according to my Hematologist.

I know you were concerned about B-12 deficiency and PA, the other poster was correct in saying, if a B-12 deficiency coexists in the presence of IDA, it may not show and appear to be a normal reading. You are too low for that. That doesn't mean that you are not low in B-12, and you were right, you should have a baseline for B-12. Anytime there is anemia this should be checked. It takes years to deplete the B-12 and you could have something beginning that might only be a little low, but regardless it would show. You could have a B-12 of 400-500 and have symptoms, but be considered normal range. It's just not right in any way (other than you don't appear to have a B-12 deficiency from your docs point of view) that they didn't check it for you:dizzy:. You will have to keep pushing that issue. Don't give up and I promise you will win in the end!! I think that your doctor wants you to take B-12 and folate now because this helps in rebuilding healthy blood cells.

I too have Hashi's (that is your elevated Thyroid Antibodies), and I am thinking that your ANA is related to that AI disease. It can come up that way I have read. Keep an eye on this, and your symptoms. Keep them written down because you can forget them and it is so helpful to go back and read. Also, keep a record of your labs for your own reference, especially with your history.

I'm a little late to this post, have you made a decision about taking the folate or not? Best of luck to you. FLFLOWERGIRL:)[/B]
[QUOTE=cgranulomatis;3873705]Hi HKK,

First of all welcome to the boards. Your question is a very interesting one, but I want to address one thing before I begin. In today's world with information being available at anyone's fingertips who has the internet, a lot of medical information goes around to people and unfortunately in many ways it's out of context. As a result, tension arises between doctor and patient mostly because doctors are horrible communicators--even if they are right about something! I'm not totally siding with your doctor, but if you look at the values you gave for your bloodwork, and you have some medical training, it's easy to see that vitamin B12 deficiency is not your problem.

Whenever someone has anemia, it is important to ask WHY. In your case, your anemia is almost certainly due to iron deficiency. Again, however, the question has to be asked, WHY do you have iron deficiency anemia? As a young woman with heavy periods, that is a good explanation to the underlying cause. Iron deficiency anemia is characterized, yes, by anemia, and evidence of low iron stores (i.e. a ferritin of <18), but there are other markers in your bloodwork which highly suggest longstanding iron deficiency. Your MCV or mean corpuscular volume (i.e. the average size of your red blood cells) is very low. Normal is between 79-97. Because your RBCs don't have enough iron to make hemoglobin, they end up becoming smaller. Additionally, your RDW is wide. What that means is that there is great variability between the sizes of your red blood cells. This suggests that rather than there being a DNA problem with your cells (i.e. in something like thalassemia) there is more of a problem in the blood getting iron. Some cells are able to get more iron than others and are thus bigger.

So what the heck does this have to do with Vitamin B12? Well, in vitamin B12 deficiency your MCV is normally LARGE. On average, people with Vitamin B12 deficiency have MCVs which are over 100. If you had BOTH iron deficiency and Vitamin B12 deficiency, your MCV would probably be in the "normal" range because the small RBC effect of the iron deficiency would "cancel out" the large RBC effect of Vit B12 deficiency.

Now on to your symptoms. I understand that your family has pernicious anemia, and yes, this does somewhat increase your risk for getting it; however, I would stop short of saying anything else. One common misconception by patients is that, if they list their symptoms to a doctor, s/he will be able to immediately tell you what disease you have. There is the idea of "specificity" of symptoms. To elucidate further, if someone walks in to the doctor's office complaining of a cough productive of green phlegm and a fever, well, that is pretty SPECIFIC for pneumonia. HOWEVER, most symptoms patients experience are very NON-specific. "Numb hands", "brain fog", "palpitations" (etc.) together do not point towards any one diagnosis at all. They are all very non-specific. This is why when people go to the doctor, it seems like the doctor isn't listening. What the patient thinks are important symptoms are rarely helpful in making a diagnosis. The doctor, however, DOES know the important symptoms, so s/he will often brush the patient's complaints off and ask specific questions. Unfortuantely, if the doctor is not a good communicator, this leads to tension.

WHOOOOOOO, that was a long-winded post, but aside from my explanation of anemia, does my explanation of specific vs. non-specific symptoms make sense?[/QUOTE]

Hi
Iam sorry but this is incorrect information here you state that B12 deficiency is clearly not her problem......Incorrect there is no B12 or HCY or UMMA results so I dont know how you can say that......
However if you are talking about PA that is different the blood now changes the cells become large...and the MCV is elevated...You still need to have the B12 checked in any case

You can have a B12 deficiency or insuffeciency without anemia.....And the symptoms listed are among them....I can list a whole lot of symptoms for your viewing it affects the whole body systems not just the blood it is serious in that it can cause a lot of damage with the correct type of B12 a lot are reversable.............I know as I am B12 deficient and I dont have anemia at all nor was my MCV elevated I had foggy head,numbness, fatigue,palpitations rapid heart rate loss of memory stomach issues concentration problems couldnt talk properly the list goes on and on..........My iron was on the low side as my ferritin but not severe vitamin D very low as was my folate........
Thyriod conditions are strongly linked with B12 and also celiac disease which can acuse B12, iron vit D and folate deficiencies.........

Cheers:wave:
I had low ferritin (18) caused me severe symptoms, but my B12 was perfectly fine and I do not believe in most cases of anemia that there is a co-existing B12 deficiency. The two often occur without the other so having them together is probably more often circumstantial than one being caused or aggravated by the other. However, I still took the vitamin prescribed by the doc which had the iron, folate and vitamin Bs. I have improved greatly because of it so I definitely think having all of them at their optimum will help your body function properly. There are rebound affects of one problem that will cause another but in this case B12 isn't a common denominator in anemia. Regardless of that fact, there is no reason not to have a doctor check your vitamins. I think everyone should have a yearly check up on their vitamins. I never took vitamins and I'm now finding out just how important they are.





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