Can anyone please help with these blood test results?

[PotOfYoghurt]

Feeling disheartened with the doctor. First of all told I only had low iron and was anaemic, so sent a prescription.

Then I asked about Vit D and B12, was sent those through and then told oh yes your Vit D is 2 and your folate is 50 and was told to get over the counter supplements. I was shocked as my mum was deficient in Vit D at 11 and had injections to boost her levels. Then I checked my results and it's the other way around, folate is 2 and Vit D is 50.

So I can see I'm low in ferritin, folate, D, ok for B12, and a bit low/borderline for some of the other blood cell ones.

Symptoms I've been having:
Extreme fatigue
Very emotional outbursts, feeling depressed

I've also been having breakthrough bleeding during my cycle, I'm often bleeding for 3 weeks of the month. This is being investigated, an abdominal ultrasound was clear and due to have a hysteroscopy soon.

So I'm not sure if anaemia is due to bleeding, or vitamin levels, or both? Does the first picture mean that I have macrocytosis, ie folate deficiency anaemia as well?

Also can anyone help with what dosage to take please, my doctor prescribed me with ferrous gluconate which would have me on 35mg of elemental iron a day, and everything I've seen says I'd need a higher dose than that for anaemia.

Also folate and Vit D dosage? The dr said just take over the counter ones but again the internet says you need a high strength one, and as I also have a high BMI I'm not sure if I would need extra again, like you do during pregnancy.

If anyone can help I'd really appreciate it, I can't face calling the doctor again to query this as I've called several times over the last few days trying to get the tests I need and the results. I'm exhausted, physically and mentally and emotionally and I don't know what to do and I just want to feel better

Are you on a restricted diet OP? It’s odd to be that low in the summer..are you outside enough during the day? Eating plenty of calcium rich foods to aid absorption?
I was really low one winter and had a vitamin D injection, but had to pay for it. I’ve managed to keep my levels up with diet in the summer and supplementation in the winter.
I’m also prone to low iron - again, I need to be careful that I’m having enough iron rich foods, so red meat, eggs etc.

Your ferritin is low and your Hb is only just normal. This could well be caused by your gynae issues. Last summer my ferritin dropped to 11, I felt awful. I was getting at least two migraines a week, I was so tired, I was pale, I felt awful. They did query about investigating it further in Endoscopy (ironically where I work) but I have endometriosis and previous Endo tests have been normal. Instead we opted for me to have a course of iron tablets which improved my ferritin levels, also tried a new approach to migraine management and all my symptoms eased. Ferritin has been repeated and is now in the normal range. I took Ferrous sulphate, I think it was 325mg? I’ve had low vitamin D in the past which improved on an OTC tablet.

I'm outside a lot, especially during the summer, as my hundreds of freckles can attest. I'm a nanny so often out in the garden/park during the day, not in an office etc.

I'm also not vegetarian, which is what someone suggested. I eat a lot of meat and dairy products.

I also have an identical twin who is very low in Vit D, even when she lived in the Middle East, and is low in B12 and ferritin as well.

As our mother is also low in D I don't know if there's some sort of genetic predisposition to not absorbing it?

I am an ex blood scientist so can help with interpreting your results. Looks like you’re iron deficient, folate and B12 deficient, luckily it’s not affected your red blood cells too much yet as your Hb is on the lower end of normal, you don’t have macrocytic anaemia as your MCV and RDW are normal, your MCH is a bit low, but other than that everything looks quite normal on your FBC so far.

If you continue to not have the correct amounts of vitamin D, folate and iron eventually you will become anaemic, it’s possible to have a combination of iron deficiency and b12 and folate anaemia if you are deficient in all of them. In which case you won’t get the typical cellular features of both types of anaemia as they tend to cancel each other out (iron= small cells, b12 and folate= large) but your Hb and MCH will be low.

I can’t give any advice on symptoms or what to do as it’s not my area.

B12, folate and iron*

@Elsiebear90 thank you! That makes a lot of sense.

@NooneElseIsSingingMySong that iron dosage is more what I thought, my sister is on 2x 305mg of ferrous fumarate a day so I'm not sure why I've been told to take this one.

You need to take folic acid 5mg daily (this strength is not available to buy and would need prescription) for at least 2-3 months and increase dietary intake if you can (just Google folate diet). I would suggest ferrous fumarate 210mg three times daily (or ferrous sulfate 200mg three times daily) which needs to be prescribed. You also need to take roughly 10micrograms vit D daily (around 1000 units) which can be bought over the counter. Also try to get 15 mins sun exposure to as much skin as possible daily (weather allowing!) to help with vit D. I would expect you GP to recheck these bloods in around 3 months. I think the low folate and ferritin is likely to be making you feel so tired, and is likely due to dietary deficiency.

Can’t help with some of your queries but I had low ferritin and was prescribed the equivalent of 130 mg of elemental iron per day (but that was ferrous sulphate so possibly not absorbed so efficiently?).

I did do a bit of reading on it at the time and a new research study had found that better results were obtained with a lower dosage of iron, if I understood correctly because if you hit the system with a large dose of iron it then thinks it’s got enough and doesn’t absorb it so efficiently (the study described it much better of course!).

You need to take folic acid 5mg daily (this strength is not available to buy and would need prescription)

You can buy 5mg on Amazon. I take this as my GP said mine was fine at 1.7 so I just bought rather than argue for a prescription.

Great, thanks everyone. This is just the sort of information I was looking for, I was starting to feel quite overwhelmed.

Ferritin looks low so would deff get some iron. you can get 200mg over the counter but you have to get it from behind the counter...those on shelves are usually redic low amounts.

My doctor said it's rare these days in the UK to not be low in vit d as people spend so much more time inside than they did historically. In addition if you are dark it's harder to soak it in and fair people keep to shade/using sun cream. Just some over the counter vit D should sort that out

I don't know about the others, but for vitamin D, yes, I would be supplementing. I have a vitamin D of 50 (all else was perfect) and I felt awful. Apparently, the ideal is closer to 100 and above. In other countries, 50 would be considered deficient. There is a protocol you can follow for vitamin D deficiency. You basically need to take like 400,000 iu or something similar (look this up, I'm just trying to explain it from memory) in 8 weeks. So I took 8000iu a day, plus once a week, I took a mega dose of 20,000iu, for 8 weeks. I felt significantly better after about a month.

I have to take folate prescribed - every time I stop it goes below 2 like yours and I feel awful. Bone tired. Pretty sure this is prescription only

Your Vit D isn’t that low - my doctor says 50+ is sufficient but 75 better

I can't help with the others, but when my ferritin is that low I take 200mg ferrous fummerate a day, or 400 if I feel really bad.
I take contraceptive pill to control periods.

Thank you all, this is really helpful

I was getting a bit anaemic and had low ferritin and folate. Tried eating the correct folate containing foods etc. Made no difference .No other symptoms, not thin. Later diagnosed with Coeliac disease.

@Shallowsubmarine

I have to take folate prescribed - every time I stop it goes below 2 like yours and I feel awful. Bone tired. Pretty sure this is prescription only

Your Vit D isn’t that low - my doctor says 50+ is sufficient but 75 better

Mine does the same, as soon as I drop supplementing it's straight back down. My diet's not the best but it's not terrible, not sure why I don't maintain the levels without tablets

There are very good b12d groups on FB that you should join.
Do not take any B12 supplements. Treatment must be with injections for life unless you are supplementing a vegan diet.

www.facebook.com/groups/707933819262618/?ref=bookmarks

www.facebook.com/groups/PAB12DSupportGroup/