I'm a 38 y-o male and was diagnosed with B12 deficient anaemia in September this year but suspect I may had it for some years previously. I don't know the cause of it. I live in Asia in a country with very limited medical expertise in this area (cannot even do B12 testing here). I've travelled to nearby Thailand for tests, but have yet to find a doctor there who knows the subject well.
My main symptoms have been: lethargy/fatigue (for many months); excessive thirst; sore, dry eyes; thinning hair; eczema/psoriasis (pre-existing for years, but worsening); cognitive problems (brain 'fog'; short-term memory problems;); anxiety & depression; some tingling/numbness in the extremities.
Key blood test results:
Early Sept 2008 (when first diagnosed):
RBC (range 4.5-6 *10^6/mm3): 4.14
HB (14.1-18.1 g/dl):14
HCT (43.5-53.7%): 41.1
MCV (80-95 fl): 99.3
MCH (27-32 pg): 33.8
RBC morphology: Abnormal RBC morphology seen. Macrocystosis: few
Lymphocytes: (12-44%): 17%
Lymphocytes: (1500-4000 /mm3): 1321
Vitamin B12 (211-911 pg/ml): 183.8
No iron/ferritin or folate tests done at this time.
Late Sept (after 4 weekly injections of cyanocobalamin, and taking multi-vitamins and B complex with iron and folate):
HB: 14.8 g.dl
MCV: 99.3 fl
MCH: 32.8 pg
RBC morphology: No significant abnormal morphology seen
Lymphocytes: (range 12-44%): 16.6%
Lymphocytes: (1500-4000 /mm3): 1204
Vitamin B12 (211-911 pg/ml): 572 pg/ml
TSH (0.35-4.94 uIU/ml): 1.832
Free Triiodothyronine (Free T3): 2.43 (range 2.0 - 4.4 pg/mL)
Free Thyroxine (Free T4): 1.22 (0.93-1.7 ng/dL)
Serum iron (59-158 ug/dl): 87
TIBC (259-388 ug/dl): 267
UIBC (112-346 ug/dl): 180
Ferritin (30-400 ng/ml):316.7
Folic acid (3.1 - 17.5 ng/ml): 11.3
Total cholesterol: 195 (150-200 mg/dL)
HDL Cholosterol (“good” cholesterol): 45 (45-120 mg/dL)
LDL Direct (“bad”): 137 (50-130 mg/dL)
ANA Profile (Antinuclear Antibody test) (normal range = or less than 1:80)
ANA: negative with cytoplasmic staining
Anti-SM antibody: negative
Anti-RNP antibody: negative
Anti-DNA: negative (0.3 IU/ml)
On doctor's advice, I had an Esophago-Gastro-Duodenoscopy (EGD) and a colonoscopy, and biopsies. My doctor said the results were all fine. There was no evidence of inflammatory bowel, no tuberculosis in the ileum, no evidence of parasites or H pylori infection, and no atrophy. The biopsy results showed:
Mild chronic ileitis with slightly flattened mucosa in the lamina propia, terminal ileum (with no increased eosinophils or parasites seen).
Moderate or mild mononuclear cells in the antrum, body and incisura. No H pylori organisms identified.
Moderate intestinal metaplasia in the antrum.
At the end of all these tests, my doctor gave no explanation for my B12 deficiency and no advice on how to proceed to try to identify the cause. She said in general there were three main possible causes: 1. Gastro-intestinal malabsorption (atrophy/damage to stomach or ileum, etc). 2. Autoimmune disease. 3. bone marrow problem. She basically said that #1 was ruled out by the EGD/colonscopy results; that there was no indication of #2 in the ANA results; and that there was no need to pursue #3 at this time.
Testing for intrinsic factor and parietal cell antibodies is not available in Thailand.
I continued having weekly cyanocobalamin injections, though have recently stopped these and started to take sublingual B12 lozenges instead (3-5mg of methylcobalamin a day, and more recently also hydroxocobalamin and adenosylcobalamin/dibencozide as well).
I've had no discernable change in my symptoms (especially fatigue, cognitive problems, thirst, thinning hair, sore eyes & anxiety) since I started having B12 injections and, subsequently, taking sub-linguals. I don't know what's happened to my B12, iron, folate levels since late September.
I'd appreciate any insights into the following questions:
1. From my test results to date, can I confirm or rule out pernicious anaemia? If I do have PA, would the ANA test (used to screen for autoimmune disorders) usually provide an indication of this, or is it only intrinsic factor/parietal cell antibody testing which is useful to diagnose PA?
2. Is there any point to me having MMA or homocysteine tests if I can find them available somewhere or is this useless now that I have been taking B12 supplements? Would it to help to determine the cause of B12 deficiency?
3. After nearly 3 months of B12 supplements (injections and then sub-linguals), should I not be feeling some improvement in symptoms, particularly fatigue? If I'm not, would this indicate some other additional deficiency, as well as B12?
4. Do my iron, ferritin and folate levels look normal for someone with B12 deficiency, and is there anything else I should be checking (such as B6 levels) as well?
5. Do my EGD/colonscopy results indicate any cause of my B12 deficiency?
6. In particular, does the "mild chronic ileitis" (inflammation) and the "slightly flattened mucosa" in the terminal ileum mean anything? (If I understand correct, the ileum is where B12 is absorbed and flattened mucosa is an indication of gluten intolerance which may result in B12 malabsorption. I don't have any reason or obvious symptoms to suspect gluten intolerance but am wondering if this could be an explanation for my B12 def?)
7. Also, do the moderate or mild mononuclear cells in the antrum, body and incisura (which basically indicate inflammation, if I understand correctly) potentially throw any light on cause of my B12 def?
8. Has anyone else suffering B12 def reported excessive thirst/dry mouth as a symptom, or is this likely to be unrelated/caused by something else?
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