[Marlene]

Please know this is just my opinion and not meant to replace the advice of your doc. It’s intended to give you some things to consider when working with your doctor.


Here’s my list of things to consider. They usually start with some standard tests to rule out the easy/most likely possibilities. It’s usually a process of elimination.

Nutritional:
Re-check B12, folate, iron, B6, D, copper and zinc. You can ask the doc to include an MMA & homocycteine to further assess B12 status, but at this point it’s pretty apparent you have a B12 issue. Regarding iron, I would request they run more than ferritin to get a good assessment of iron. Ask for Transferrin, TIBC, UIBC and serum iron in addition to FE.

Heavy Metals:
You may want to ask them to check for lead and other heavy metals.

Other diseases and reasons:
Anemia can be a result of other chronic diseases like auto-immune diseases; digestive disorder like....crohns, h.pylori bacteria, celiac disease, malabsorption issues; Kidney and liver problems; blood loss; heavy use of antacids; metabolic issues where your body does not convert nutrients to a usable form....like B12, most supplement require the liver to convert it to a usable form; medications.

Bone marrow disorders:
SAA, MDS, blood caners, PNH

Genetic:
There are genetic reasons for anemia that should be tested for if they suspect a bone marrow disorder.

Hormones:
Low testosterone levels.


Finally, at this point, if were me and my appointment with the hematologist isn’t till June, I would address the B12 with at least 5000 mcg of oral Methycolbalamin B12. I would take it by itself 1/2 hour before eating or 2 hours after eating. And I would start off with 1000 mcg for the first two days, up it to 2000 mcg for two more days, etc, until I got to 5000 mcg. Once I got to 5000 mcg, I would add in a good B complex. The B vitamins need each other to be effective. I would also consider a good probiotic to help balance the gut environment. Or, push B12 shots with my doc. There’s no good reason not to. If you do increase your B12, let them know you are supplementing because it will show up as an increase in B12 serum reading and can throw them off. What’s good is that you have a baseline of your B12 now and will be able to assess effectiveness of supplementation. I would also consider stopping all supplements about one week before the appointment.

I know I sound like a broken record but B12 is vital to blood production, mental health, central and peripheral nervous system, and most importantly, to healthy RNA/DNA production and gene expression. It can take a while to restore B12 and then to correct the problems created by it.

Hope this helps,
Marlene