Full blood count - Can anyone help advise what to do next?

[VillageFete]

Firstly, i’m so sick of my GP surgery. I’ve never bothered them unless desperate, and now I’m desperate and am being fobbed off, so I had a full blood count done privately. I am wondering how to broach my GP and request further testing as the last few times i’ve been, they just don’t care.

I have intense, sharp pain in lower right groin. Comes and goes, no rhyme or reason to it, but it’s making my life miserable. It floors me at times. I suffer with constipation and bloating too.

This pain is possibly gynae or nerve damage as it started not long after my C section 3 year’s ago, but due to the constipation and bloating, I have worried it could be the bowel.

After visiting my GP 4 times over these issues which are becoming worrying, they agreed to a Calprotectin test. It came back at 47, which is apparently normal, they also suggested a Celiac blood test - again, came back normal. So now they won’t entertain it being a bowel issue. I paid for a private FIT to check for blood in the stool for peace of mind in January and it was negative. I’m going to pay to do another because i’m sick of the bloating/constipation.

Besides the pain and the constipation/bloating, I am so fucking tired. I feel wiped out and get waves of utter exhaustion. I feel like I have what I can only describe as total brain fog, I also occasionally get lighthearted and sometimes it feels like my heart skips a beat.

GP won’t do full blood count, says it isn’t needed so I paid for my bloody own with Medichecks. I will post the results below, but I think it’s unlikely I have iron deficiency anemia (Thankfully) But Googling the MCV and MCH, I’m thinking I could have a B12/Folate deficiency going on? Maybe even Pernicious anaemia?

Haemoglobin - 137 g/l : Normal
Haematocrit - 0.402 L/L : Normal
Red cell count - 4.11 : Normal
MCV - 98.1 : Borderline
MCH - 33.4 pg : Abnormal
MCHC - 341 g/l : Normal

White cell count - 5.4 : Normal
Basophils - 0.12 : Abnormal

There’s others under the white cell count but all saying “normal”

I just feel like shit and often miserable now because of the way I feel.

Can anyone please give their insight and advise me how to approach my GP on this. What can I ask them to do? They don’t believe I need a colonoscopy due to Calprotectin test being normal, plus my bloods don’t show iron deficiency anemia (Any other way to diagnose that? Should I have checked ferritin?) But something just isn’t right with how I feel these days. I get enough sleep, I shouldn’t feel this shattered and weak! It’s really affecting my quality of life and making me so anxious.

@Sunnysideup999 They’ve never mentioned appendix, which I find odd. I will mention it.

I’m 36. Opposite end of menopausal, lots and lots of eggs left. I have PCOS/hormone imbalance and don’t ovulate, my periods are very light and not “normal” hence me having to go private for investigations. All was ok with my endometrium but I would need a laparoscopy to check for adhesions etc that cause pain and I don’t have 7k to pay for that!

I’m sorry that you’re going through similar. It’s crap.

I keep reading that low B12 and Folate is somewhat common and can cause the symptoms i’m having, but also reading that many GP’s don’t seem to understand/empathise with the condition!
This is correct. High mch (and 33.4 is high) is characteristic of megaloplastic anaemia, most commonly cause by low vit b12 absorbency. Most doctors will do a standard b12 serum test. The problem is this doesn't test how well it is absorbed so you can have a going level but not absorb enough.

Like you, I had the same mch level but normalise b12 serum (444) so my doctor consider it was normal a d just said the high mch was just one of those things and not meaningful.

After months of feeling very unwell, I did research and read that it's possible to inject oneself safy as you can't overdose on b12 so offered some one and started injecting as I would have at my practice. I first felt worse and then gradually bit better. I had to continue to inject every other day for a few weeks and finally my symptoms disappeared gradually. Its been 4 years now and I know exact when I'm due another injection. I start to get breathless on exertion, my heart rate goes up high even on low impact work out and my legs feel heavy. 3 days after an injection and I go back to feeling great.

What you need to ask your gp, or pay private is for an ACTIVE B12 serum. This will test how well you absorb b12. It is a much more reliable test. Even the nhs Web page advice states so.

@vivainsomnia Thank you so much. I will go armed with the knowledge from this page! I will ask for an active test and if they won’t oblige then i’ll have to pay.

When starting another round of IVF to complete our family, I did actually have B12 checked. That was 2 years ago now and it was 416 ng/L But of course, I wouldn’t know how much of that was active as it was a standard NHS test and as I say, it was 2 year’s ago! My serum folate was 4.8 ug/L but I have no idea what this means.

Funnily enough, my partner has flown out to our fertility clinic to do his “bit” Their blood tests are absolute pennies. We spoke yesterday and I suggested he get a full blood count and get his Folate/B12 checked as he suffers from exhaustion and headaches. His full blood count results seem fine, his MCH is 30 pg, MCV is 80.64 - I think these are ok?

But his B12 is 287 pg/ml and the fertility clinic said that they suggest he looks in to supplementing when home.

If MCV and MCH are ok, why would B12 be low?

His Folate was 13.87 ng/ml
Serum iron level 144 ug/dl

mch is not always affected by low b12. His results are low but if he aborbs it well, it might be OK. Or indeed, it could be the cause of his headaches although these are not the most common symptoms and there are usually quite a few more with a deficiency but we are all different.

An active test is the best test although again not 100%. The only way to really know is to inject for some time and see I the symptoms get better/disappear.

Your GP should agree to an active test. Make sure you don't take any supplements that includes b12 or it will give a false result.

Thank you @vivainsomnia I really appreciate you taking the time to advise.

I’m currently taking a pre natal with B12 in. I do need to stay on it for one more week. How long should I leave it between that and having my active B12 bloods done? It also contains Folate. I don’t think it’s doing much because I constantly feel like shit 🫣

No it wouldn't help much at all if the problem is with absorption. Only injections will make you feel better if b12 is indeed the issue.

Sadly, they say to wait 4 months before doing an active test for it to be accurate.

if you do have a b12 issue, taking folate can mask it to some extent because it corrects the macrocytic anaemia so the fact you are taking prenatal vitamins might be going against you slightly here.
both b12 deficiency and folate deficiency (your level was low but assume that was before you started taking the vitamins?) can cause infertility so it'd really be worth you pushing to get these checked
NHS LINK

Have you had covid OP? B12 deficiency is common after covid. I had all the symptoms but my gp never checked the level. I paid privately to have injections and a lot of my symptoms went away. I'm still fatigued and have brain fog but I have long covid too. I'm asking for a trial of HRT too soon but I'm in my 40s.

I would try and sort out your constipation as you cant tell what is causing what at this point. Try increasing the fibre in your diet, lots of fluids and things like prunes or linseed help. I'm sure you know all this. Failing this some softening laxatives. Avoid stimulant laxatives like senna other than very occasionally or for short term use.

Thank you all so, so much. What a wonderful soundboard you have been.

Regarding Covid, I had it in January 2021 so not recently.

UPDATE - Saw the best GP in the world this morning. Never seen her before, she’s been on maternity leave and is doing keep in touch days. She was so understanding, thorough and actually listened to me and empathised.

She has sent me for a plethora of bloods, another FBC, ferritin, folate, B12 etc… Although probably not the active B12 one so I’m guessing I should get that done privately.

She examined my back passage, she listened to my heart and done my blood pressure. She must be a bit concerned because she commented on my BP and is sending me for an ECG. I’ve been lightheaded today so i’m guessing BP was low. Depending on what happens with bloods, she is referring me to those who deal with the bowel (due to the stabbing pain and constipation) But to be honest she isn’t convinced they’ll see me.

I suppose I need to stop taking the prenatal and I need to get an active B12 test done?

The closest appointment for bloods is 2 week’s away.

I'm so glad you were able to see a better GP who actually took it seriously!

Hello. Did you get to the bottom of this?