Low folate/Low ferritin.. HELP

[Josephinesmith49]

Hi, I've been having a range of symptoms for months including extreme tiredness, dizziness, palpitations, extreme bruising etc etc. I've had a blood test carried out the other day, only recieved one lot of results back so far.
My folate levels are 2.3.
My ferritin levels are 24.9.

It's over the weekend so has been auto filled on the system as normal- no further action. Everywhere I look online show anything for folate under 3 is a definite folate deficiency & whilst my ferritin has been lower before (18- requiring iron tablets), i can find that the NICE guidance states anything under 30 is an iron deficiency.
I am going to be fuming if the doctors mark it as normal (which i think they will).
I feel like utter death- i have all symptoms of folate deficiency.

Please can other people let me know there past experiences / some advice please.
I'm tempted to even go private as I'm struggling to function day to day. I'm in my late 20s & i shouldn't be feeling this awful!!!!!

Thank you :)

I think you need your B12 checking too if you have low folate. GP’s will mark ferritin as normal because the lab reference range will say it’s normal, even though under 30 should be treated and ferritin needs to be above 70 for healthy hair growth!
Be aware they mark b12 as normal when it’s quite low too. The labs reference ranges don’t seem to trigger unless below 150, but nice guidelines now say treat if below 180 and treat is symptomatic below something like 275.

Hey thanks for the advice!
I've just checked and my B12 is 303- so at least that's in normal range!
What do you think about my folate? As far as I can see everywhere I will need supplements?
It just winds me up that the doctors reference ranges are so large & go down so low and I'm feeling horrendous!

I know for our labs reference range below 5 is counted as low for folate, but lab reference ranges vary because they may use different equipment in different labs.

My GP actually stopped my prescription of iron when my levels got to 20. 🙄 I just monitor my results and treat myself for pretty much everything these days- it’s ridiculous!

Did they test Vitamin D? That can cause extreme tiredness, but I know they’ve stopped testing in lots of areas. I hope you feel better soon

Thank you for your advice ☺️
I am having my vitamin D tested, annoyingly when I went the other day they'd run out of the white capped tubes to send the sample off in, so annoyingly I've got to wait until the 3rd April to have that tested!!
I'm just wanting some answers 😫
Fingers crossed they will give me some folic acid!!!

I went private with similar symptoms to you, OP. My ferritin was 4, folate 2.7, HB 110, b12 was 290. Gp said take some OTC iron tablets.

It was absolutely worth it. For the first time I felt someone was listening and rather than saying oh, that’s more or less in guidlines, said no wonder you feel like death, let’s sort this out.

I don’t know where you are in the country, but I can recommend Dr Klein in Cambridge, who specialises in iron and b12 deficiency.

Oh wow a ferritin of 4- you must've felt awful!!
Yeah its so frustrating as I really don't feel listened to, if they ignore this I am going to have to go private!
I'm based in Lincolnshire, but thank you for your suggestion- I might do some research later into any private people around here!

Do you mind me asking when you went private did they prescribe you various supplements/ did you have infusions etc?

I thought a deficiency in ferritin and Folate indicated pernicious anaemia and needed treatment definitely. I had very low ferritin but good folate levels so just an iron deficiency for which I take high dose Ferrous fumerate which I buy otc as it’s cheaper and it’s helped a lot. I have relatives with pernicious anaemia and its definitely not a fun condition.

I thought a deficiency in ferritin and Folate indicated pernicious anaemia

PA is b12 deficiency, but even then it’s only PA if you’ve had an intrinsic factors blood test which indicates it’s PA rather than diet/lifestyle. PA needs 3 monthly injections of B12 (hydroxocobalamin) for life.

@NotHavingAFunTime ok that’s good to know. Still could be an iron deficiency I guess, probably wouldn’t do any harm to buy some prescription strength supplements otc and try for a month. It made a noticeable difference to me within a week or two.

I had to send my blood results to him in advance. I also have an under active thyroid.

We agreed in advance that I definitely needed an iron infusion. And that the b12 was on the low side of normal- he felt b12 should be above 300. He said it could be caused simply by diet (I’m vegetarian), or an issue with absorption and that we’d discuss it at the appointment.

At the appointment he said it was up to me whether I wanted to try oral b12 supplements or go in big guns with injections to raise it. I decided I’d rather go in big guns as the symptoms for all the conditions overlapped and I felt so awful I wanted to throw everything at it to give myself the best chance of feeling better asap.

So at the appointment I had an iron infusion (1200 monofer I think) and my first b12 injection. I was also prescribed 5mg of folate. He prescribed 10w worth of twice weekly b12 injections and folate pills. I had to take folate at the same time. I can’t remember the exact wording but the gist was all three - iron, folate and b12 work together so you need good levels of all three for each to be able to be absorbed properly/work as they should. He also suggested I take daily vitamin D supplements (I didn’t have recent results for that but had previously been deficient but given a month long course by the GP in 2022 and I was never tested again to see if it had improved. He said they often went hand in hand).

We talked through my symptoms and he asked if I’d ever had investigations as to whether my thyroid issues were autoimmune (I hadn’t). He said autoimmune conditions often come in groups so he tested me for several others. He said it was possible that the b12 was lower than he’d like because I wasn’t absorbing it properly. The results came back two weeks later as positive for hashimotos for the thyroid and also for parietal cell antibodies. This meant I had autoimmune gastritis and my body was attacking my parietal cells. The parietal cells make intrinsic factor which is necessary for b12 absorption. Therefore I wasn’t absorbing b12 properly but we’d obviously caught it fairly early before my numbers had really dropped. He said to continue injecting b12 twice weekly.

Thank you so much everyone for your advice!

Updated today!!!! Turns out they did actually measure my vitamin D & it is "dangerously low'.
So now been started on 50000unit capsules for 6 weeks. Just so glad to have some answers 😊

Hi. Glad you’re getting some answers!
I had ferritin levels of 26.6 and folate of 1.5.
im taking folic acid and iron tablets. My bloods were fine just before I started feeling really weak, loss of muscle tone etc. I had them done for cracked fingers tips, cracks in the side of my mouth etc then I started with fatigue etc! I’m wondering if they’d actually be lower now but who knows.
i am due back at work after MAT leave and will be doing 12.5 hour shifts. I have more bloods at the end of the month for liver, thyroid and vit D.
my boss wants to risk assess b it is questioning if I am fit to work. Not sure if I’m tired as my girl is teething and I have a 1 and 4 year old to look after. Feel like I’m going insane and don’t want to be for work if I’m just tired from having kids..

Update after 6 weeks of my vitamin D loading dose... I feel incredible!!!
If you're feeling down, incredibly tired etc etc please see your doctor about potential low vitamin D! I can't explain how amazing i feel, at the beginning of these 6 weeks i was crying everyday, debating going on antidepressants but now I feel like a new woman, I love life again?!

My Folate was low at 0.8 when I had it tested back in March time, my B12 and folate were okay. My vitamin D was low too at 23. They told me to buy some folic acid tablets and gave me a course of high strength vitamin D.

My Haemoglobin has been on the low side all year but has now dropped to 88 no wonder I feel so tired.