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Forum Name: Hematology Topics

Question: Diagnosed deficient B12 - But don't know why?


 jad1976 - Tue Nov 04, 2008 10:53 pm

I was diagnosed last November with a severe B12 deficiency. I have been on B12 shots ever since. I feel "much" better as opposed to the years leading up to my diagnosis. I was so sick every day that I literally thought I was dying. I had major digestive problems, heart palpitations, difficulty breathing at times, heart burn, nausea, severe headaches, ringing in the ears, hair loss, leg pains, joint pains, beginnings of vision troubles, lethargy, severe anxiety and mood swings, twitches, seizures where I'd smell things that weren't there and unable to focus on my surroundings for minutes on end, sleepiness during the day, overactive bladder and nocturia, bleeding gums, loss of appetite and the list goes on. I finally switched doctors and got some answers. My question now is.. "Why am I deficient?" My doctor says it's way too "complicated" to answer that, but I don't believe him. I want to see a haematologish, is the correct specialist to request and do I have that right to do so? I think I may be anemic or have pernicious anaemia. Although a great majority of my symptoms have subsided I still have some that remain. I know that because my B12 deficiency went a long time without being diagnosed that some symptoms may be irreversible, but does that also go for bleeding gums? My dentist has ruled out any problems with my teeth and gums. It is something else that is going on. They bleed way too easily. I also still have tingling in my feet and hands at times. One times a few years ago after being given yet another blood test, I was called back to the doctors immediately because either my red or white blood cells were very low or high, I can't remember. But after another blood test, they dismissed the first results. I think it was a sign of something, but they never followed up on it. Does anyone have any insight on anything I've listed? Any information or thoughts would be greatly appreciated.
 Dr. Tamer Fouad - Wed Dec 10, 2008 3:33 pm

User avatar Hi,

I am glad that you feel better. Your doctor is right in that there are many factors that can contribute to B12 deficiency. The absorption of B12 is amongst the most complex in comparison to other vitamins. It involves the secretion of a molecule called intrinsic factor which then combines with B12 ingested in the diet, it then travels to the terminal ileum where the combination is absorbed. Any excess is stored in the liver.

Any problem in any of the above processes could lead to B12 deficiency. One test used to distinguish the cause is called Schilling's test and is a complicated test that involves ingestion of a radioactive form of B12 and then measurement of B12 levels in urine before and after intrinsic factor.

The thing is while mild forms of B12 deficiency can be troublesome they are easily treated and rarely if at all leave permanent disabilities.

Subacute combined degeneration is the a neurological syndrome associated with severe long term B12 deficiency and involves degeneration in the central as well as the peripheral nerves. This a severe syndrome that can be associated with severe manifestations such as muscle paralysis.

Why do you feel you have anemia? If your blood tests are normal then you don't have anemia. Anemia is a lab diagnosis based on your hemoglobin level and your hematocrit level.

As long as you continue to improve then you shouldn't be worried. If you stop improving or something new arises you should contact your doctor. Of course feel free to consult a hematologist although your doctor may not feel there is a need for a referral if all your tests are normal.

Best regards,

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