Folate Deficiency vs. Vitamin B12 Deficiency - Diet and Nutrition - Hematology

[@MedicosisPerfectionalis]

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[@asimmemon8313]

Sir can you talk with me

[@asimmemon8313]

This anemia is HIV Early symptom

[@asimmemon8313]

???

[@MedicosisPerfectionalis]

Hey, How are you? How can I help?

[@elaineluther1799]

What is the reticulocyte production index? Conceptually, the reticulocyte production index (RPI) is a way to correct the reticulocyte count when anemia is present. Because reticulocyte count is a percentage, it can be distorted by the relative amount of RBCs. When RBCs are low (anemia), then the reticulocyte count will have a higher percentage, giving the false illusion that all is OK with the reticulocyte world. So, when patient is anemic, the RPI mathematical formula is used, which is RPI = reticulocyte count x (patient's low anemic Hct) divided by normal Hct (45 for a man,; 40 for a woman). You might find patient's bone marrow response is not as great as you thought!

[@MedicosisPerfectionalis]

🩸 Hematology Playlist: kzbin.info/aero/PLYcLrRDaR8_eoNz6dxXolh1XMEietcniU&si=tomFsUjAgOKhOJVq

[@Iccdoc]

B12 deficiency can be treated very well with oral OTC B12. I am a physician who had to retire at age 58 due to the psychiatric effects of undiagnosed B12 deficiency. My B12 level was 120 pg/ml. I was mildly anemic with a hemaglobin of 12.6. I diagnosed myself and started taking 5,000 mcg of OTC methylated B12 four times per day. I am now just taking one tablet every four days, and I am doing quite well on that. Studies have shown that the oral B12 is more efficacious in the long-term in treating B12 deficiency. I have autoimmune B12 deficiency which is Pernicious Anemia. I did take iron as well, and the anemia cleared up rather quickly. I have a great aunt who had Pernicious Anemia and died in a swimming pool from a sudden rupture of her abdominal aorta. She had stopped going to the doctor for her B12 shots for some unknown period of time before her sudden death. It is well known that B12 deficiency has a degenerative effect on blood vessels.

[@abdulrashid2143]

Can it cause hairloss? I have B12 level 409 pg/ml, while folic acid level is

[@danch10]

Very well but the B12 oils or the lozenges are much much better and more effective

[@CMcKay-82]

Literally this makes no sense. Oral B12 will NOT work for pernicious anemia! PA literally means you do not have intrinsic factor and therefore can NOT absorb B12 via digestion. You MUST recieve intramuscular injections so they bypass gastro and go directly into bloodstream. I call bull$hit.

[@binathere2574]

Pernicious Anemia needs b12 injections. It will not resolve with tablets

[@binathere2574]

​@@jbeauty4150 of you have PA you need injections for life.

[@heartmomma6460]

Love your videos. Very best one's pit there. The pictures are at the right speed & clarity that a severe brain dead tired anemic like myself can get clarity from. Keep up the great work.

[@marksabaduquia6880]

thank you for the free medicine class

[@MedicosisPerfectionalis]

You’re very welcome 😊

[@dianadelvalle161]

I had so many "gaps" in my knowledge while studying... Now everythig makes sense. Thank you so much! Please, please do a video on homocysteine/homocystinuria/homocysteinemia.

[@MedicosisPerfectionalis]

Thank you so much 😊, Diana! Your kind words mean the world to me! I will add this topic to my list!

[@KFSBonder]

@@MedicosisPerfectionalis have you already done it?

[@bilalahmedbilalahmed3212]

Thank u sir.All the videos are excellent.I find it easy to read the topic from book after watching ur videos.

[@MedicosisPerfectionalis]

That’s exactly what I wanted to hear...Thanks, brother!

[@jamshaidkhan2971]

It's frustrating looking for answers in the comments. Please try to give the answers in the description and we won't have to change apps and won't get distracted 😅.

[@MedicosisPerfectionalis]

Thank you so much for your feedback

[@theunexpressedable]

This is so helpful! Thank you!

[@MedicosisPerfectionalis]

My pleasure 😇

[@fatimasuleman1980]

Retic count *pts hematocrit/ normal hematocrit. If less than 2.5 than usually nutritional deficiency anemias.

[@kishorerajurkar2271]

You are just outstanding . Superb teacher

[@Cutter1888]

Tremendous video, doc.

[@MedicosisPerfectionalis]

Thank you so much 😊

[@Cutter1888]

@@MedicosisPerfectionalis You're very welcome. 👍

[@courtneyvires354]

What does it mean when my b12 is high but my folate is low?

[@MedicosisPerfectionalis]

I don’t know your history, physical exam, or other labs…Please talk to your doctor…I wish you all the best!

[@kishorerajurkar2271]

What is RBC count . Does it increase or decrease in Macrocytic anemia I have cases with microcytic anemia . Thalassemia trait as well as Iron deficiency. In India we also have Dimorphic anemia. How to diagnose

[@annjean4369]

Excellent video! This video is very informative and useful! Thank you for sharing.

[@MedicosisPerfectionalis]

You are always welcome!

[@jillpelt]

I hope you can help me with my question. I had an undiagnosed vitamine B12 deficiency and now get IM injections. I'm looking at my bloodwork to make arguments for vitamin B12 deficiency because doctors here are terrible with diagnosing. Im doing much better after injections and my bloodwork has stabilised. My reticulocytes were 15 o/oo and now 18 o/oo (normal occurence with start treatment). This value is different from others on the internet in percentages. Do you know what my reticulocytes are in percentages from that value?

[@souringhosh448]

Please make some biochemistry metabolism videos..you are the best

[@MedicosisPerfectionalis]

I will! Thank you 🙏

[@sarahgamaleldean3775]

Thanks a lot ..l prefer your videos so much

[@MedicosisPerfectionalis]

My pleasure 😇

[@ferrariunicorn]

Do you have a video on red blood cells expiring before they are maturing?

[@spirosspyridon5327]

Thanks man for info

[@MedicosisPerfectionalis]

You’re always welcome 🙏

[@marksabaduquia6880]

if you want a simple explanation you were attacked by microscopic aliens and you need the avengers

[@sanashaikh1442]

I am so thnkuful u sir, I can't explained how much I am happy ,u provided free medicine leacrure this is the only week point me,thnku So much from india

[@mariamkhraibet7166]

Reticulo means net work and cyte means cells (baby RBCs) and it must be between 1-2%

[@niharnayak6417]

RPI = CORRECTED RC/2 or (Patient's HCT or Hb/Expected HCT or Hb for age and sex) x RC/2

[@fatimasuleman1980]

Thank you so much Dr!

[@bwagner1722]

I hope you see this.. So b12 deficiency runs in the family on my dad's side. I didn't really have that in my dna test. I have mtrr a66g which is I think the ability to reuse b12. Anyways I've had fatigue on off my whole life. Tingling in hands and feet. Red ear syndrome which I don't think is related etc. However my blood test always come back normal. Is it still possible to be deficient with normal serum b12 ?

[@witnessthewrath8061]

My MCV is 88 but my MCHC is 36 and hemoglobin is 17.5

[@fatimasuleman1980]

Can you tell what happens to the homocysteine levels when vit B12 is more than normal but folate is decreased?

[@tanvirahmed-rr7vt]

It may increase

[@bombblast981]

18 years old student came to his physician with the following symptoms Abnormal paleness or lack of color of the skin, Yellowish skin, eyes, and mouth (jaundice), Dark-colored urine, Fever, Weakness, Dizziness, Confusion. His lab finding is as follows: Hb Decreased Reticulocytes Increased 5 to 20% MCV Normal MCHC Increased Bone marrow Erythroid hyperplasia Coombs test Direct is positive RDW Increased Serum bilirubin Raised RBC Morphology Normochromic and normocytic What is your diagnosis?

[@MedicosisPerfectionalis]

Is this a real patient or an exam question?

[@bombblast981]

It was in my exam ?

[@Abdul_Raheem98]

Mds?

[@amy262]

What about vitamin b deficiencies for people genetic issues, such as mthfr c677t? In my area the are either a lot of doctors that don’t know what vitamins I should take or what I have seen online is wrong. I know there are so many factors to consider, but what type of doctor can give me the correct information?

[@MedicosisPerfectionalis]

A pediatric hematologist or a hematologist.

[@zubiaali444]

Excellent excellent excellent 😍😍😍

[@MedicosisPerfectionalis]

Thanks 🙏

[@rockycycle2682]

Thank you!!

[@MedicosisPerfectionalis]

You’re always welcome!

[@exxonein7729]

I have neurological problems but my overall b12 count has come back fine is it possible that i still have a b12 deficiency?

[@TheJimmyswe150]

Can be loads of things, try liquid chlorophyll wish has copper in it wish also has the same symtoms as B12 deficency, also take a b complex, vitamin d with k2, eat healthy, probiotics, you name it, just do your research, you also need to take folate with B12, not folic acid, so methyl b12 and folate

[@1273mel]

Yes you can and trying to get a Doctor to listen is hard, every NHS trust has different levels of what is acceptable so if your GP tells you it’s fine you could move to a different county and you could get supplemented, I have been through all this with different Doctors, even on the NICE website which the NHS have to follow, it states that if a patients levels are fine but still presents with low B12 symptoms then supplementation is recommended, my advice is get as much evidence as possible and present it to your Dr, and there’s a lot of helpful info on this linkwww.b12deficiency.info/ I also found out that if you take any sort of acid relief medication it prevents your body from absorbing B12 as this is what happened to me after having gallbladder surgery, I hope this helps a little

[@exxonein7729]

@@1273mel thanx Mel 👍🏻

[@1273mel]

Lfc Scouser that’s ok cus I know how annoying it is, because Drs don’t listen so I’ve done my own research over the last couple of years and learnt so much about health and how deficiencies/gut health etc can impact on the body, Drs either put everything down to anxiety or dish out pills just to get you out of the door...also if you did want to supplement with B12 you can’t overdose on it as anything the body doesn’t need you pee out, I purchased a daily oral spray and I wouldn’t be without it

[@sunnydee5998]

Question my 17 yr old daughter has a slightly low wbc @ 4. Low platelet @ 133 High MPV @ 13.9 She was having heavy periods And stomach issues like ibd The doctor is doing another cbc & blood smear I'm just worried No I'm not a student but my mom was a N.P and I picked up alot of medical knowledge from her. But pernicious anemia and autoimmune disease runs in the family But of course The Big C word scares me more than anything Suggestions on what you might think it is?

[@MedicosisPerfectionalis]

Wait for the results of the CBC and smear.

[@snehajpraj9100]

Thank you so very much.

[@MedicosisPerfectionalis]

My pleasure! Thanks for watching!

[@نورالهدىعباس-س5ك]

RPI = Hct of patient /normal Hct * retic count

[@harmianaaa]

Immaculate, thanks doc

[@MedicosisPerfectionalis]

My pleasure 😇

[@explore_with_sagan9596]

How many months does it take for the b12 supplement to work?

[@Iccdoc]

It starts working right away. How fast you improve is directly related to the dose you are taking.

[@asmaidris]

Which is the best to buy on Amazon? My hair is falling out

[@redmoon8217]

My blood test show I was low in folic acid. I ordered folate because suspect I may have methylation problem. I took bone yesterday and all my inflammation and nerve pain increase. I had horrible rise in histamine. When I googled it said that folate can raise histamine. Please can someone tell me how can I raise my folate without this reaction?

[@SoulTarot90]

I had b12 serum coming back fine yet i have had high homocysteine high, does that mean i don t have sufficient b12 even though test came fine? I feel so bad since 5 years... no one knows why

[@okidoki3201]

Functional deficiency

[@kuldeepbrar5677]

Get your coagulation profile.

[@hosamabbas5014]

Children.8-1.8 Adult .5-1.5

[@brandonxs9r659]

I take b12. Should I also take folate; or is it unnecessary to take them both?

[@sohanirahman720]

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.

[@miranomar1460]

Great Job👏👏

[@MedicosisPerfectionalis]

Thank you...Thank you...Thank you 😃

[@singinprofessor5260]

B12= 1297 on my husband’s last test He’s feeling fine but I’m worried Any suggestions?

[@sumeenahmed5099]

Facing same problem how r u now

[@singinprofessor5260]

@@sumeenahmed5099 Don’t know yet Dr stopped multivitamins but I don’t think it’s a problem I’ve read that it can actually be a sign of LOW b12 bc it’s not absorbing

[@singinprofessor5260]

@@user-tx5rx3mz8b So far so good 💖🙏🏻

[@thegodfather4663]

How long does it take for the folic acid tablets to start working

[@lyssbeth]

The Godfather i took some and was told several months... but it’s definitely worth it

[@raihanginanjar6618]

thankss a lot

[@MedicosisPerfectionalis]

My pleasure 😇

[@85sheena]

What does a low MMA count mean? Thank you.

[@aatifff858]

I am deficient in b12 but have good hg level and RBC . Should I take methylecobalamine injections?

[@MedicosisPerfectionalis]

Talk to your doctor!

[@dinaelsherbiny1727]

Awesome , but I have a question if b12 deficiency can I give folate as well with b12 or should I wait for folate lab value to confirm it's deficiency ?

[@MedicosisPerfectionalis]

It doesn’t do any harm, plus the folate level test doesn’t take long (it’s not like bacteria culture)

[@dinaelsherbiny1727]

Thank you so much, I'm grateful to you.

[@MedicosisPerfectionalis]

My pleasure 😇

[@fatimazahrarahali458]

The administration of folic acid to a patient with vitamin B12 deficiency may worsen neurological symptoms. Check out these two articles : www.ncbi.nlm.nih.gov/pubmed/7796091 www.ncbi.nlm.nih.gov/pubmed/17972439

[@nouryakzan9943]

@@fatimazahrarahali458 yeah I think you are true in case he have both deficient (Vit b12 and Vit b9); and he takes Vit b9 ALONE.. This is going to lead to severe neurological sxs becz the Vit b9 supplements are going to react with the remaining Vit b12 in his body ;and no remaining Vit b12 for melanoyl coA pathway so severe neurological sxs are going to appear. BUT, here the patient asked if he can take both together Vit b9 and Vit b12..

[@bombblast981]

A 12 years old girls was seen by her physician. Her chief complaints were shortness of breath, muscle weakness, abnormal paleness of the skin, glossitis (swollen tongue), loss of appetite/weight loss, diarrhea, nausea, fast heartbeat. The relevant lab results were as follows: Peripheral Blood Picture: MCV 110 fl (77 to 93 fl) MCH 34 pg (27 to 32 pg) MCHC 24 g/dl (20 to 25 g/dl) Hb low RBC count reduced DLC Marked neutropenia, hyper segmented neutrophils RBC shows Macrocytosis, anisocytosis, poikilocytosis, polychromasia. What is your diagnosis?

[@MedicosisPerfectionalis]

Is this a real patient or an exam question?

[@bombblast981]

It was in my exam ?

[@scottfleetwood1991]

I have high MCH, MCV, Hemoglobin and Hematocrit. My Reticulocyte count is 1.8 but my Absolute Reticulocyte count is high @ 90180. I’m waiting for my Homocysteine levels. I’m leaning towards Folate deficiency. Does anyone have any thoughts or ideas?

[@amberleebosman4164]

My folate is 9.8 is this normal

[@About36Greekss]

I have high RDW , low mch and low mcv What does this mean ? My hemoglobin is also slightly low

[@MedicosisPerfectionalis]

May be iron deficiency anemia. But, I am not a doctor and I cannot diagnose you on the internet. Please talk to your doctor! I wish you the best!

[@About36Greekss]

Medicosis Perfectionalis thanks for the quick reply ! I’ll go in next week for vitamin testing/bloodwork

[@MedicosisPerfectionalis]

Excellent! Keep me updated!

[@neroetal]

@@MedicosisPerfectionalis i hope she got well

[@momoary5740]

Thanks, but I have problem with stomach, I have bloated stomach, dry skin, dry scalp along with extensive dandruff and much more..which vitamin B could be. When up my diary consumption o feel better. But I am tired of diary, any suggestion?

[@MedicosisPerfectionalis]

I don’t know 🤷‍♂️ Please talk to your doctor!

[@TheJimmyswe150]

Lmao, maybe leaky gut, ibs, candida, sibo, probably deficency in all vitamins, its hard to tell by your symtoms, and for the love of God don't consume dairy, no wounder why you are bloated

[@TheJimmyswe150]

Also just take a b complex you should never take a b vitamin by itself if its not b1, liquid chlorophyll now foods brand great for dry skin

[@TheJimmyswe150]

But there are more than that, you need to change your diet, extremely healthy, alot of veggies, maybe keto diet and vegan also, get some probiotics also

[@MedicosisPerfectionalis]

You don’t know the diagnosis, how can you recommend treatment?

[@PinkFlowers365]

ty

[@MedicosisPerfectionalis]

My pleasure 😇

[@kurdishfood9626]

you forget an important thing in different between B12 and Fol. which is storage.mo.for folate and years for B12....thanx

[@MedicosisPerfectionalis]

Mentioned it in my Vitamins playlist.

[@manuellestpierre5600]

2.5

[@ufhhggcvhvcjhv]

Thank you for the explanation My hemoglobin is 153 ( High) Mcv is 82.5 (low) Iron serum is 25.8 (high) this is my functional medicine ranges but i am confused what type of anemia do i have? Is it pernicious?

[@MedicosisPerfectionalis]

Your hemoglobin is 153?!!!!!

[@ufhhggcvhvcjhv]

Medicosis Perfectionalis yes Hemoglobin (SI) 153 - normal to optimal range is 135-150 g/L According to functional medicine test ranges. My folate was also high 40.68 and the normal to optimal is 14-36 nmol/L Confused!

[@ufhhggcvhvcjhv]

Medicosis Perfectionalis i had some gut issues and hypochlorhydria , h pylori and candida due to long term use of anti Acids i did treat these but need to know what type of anemia is this.

[@JunkYard_Boys]

My MCV is 70 only...what does that mean

[@MedicosisPerfectionalis]

What’s the Hemoglobin and hematocrit?

[@asimmemon8313]

This is early HIV symptoms?

[@ImanFatima-o4p]

I request u to reply me first of all Plz tell me that can i use folace and myfol together??

[@alaminmughrabi84]

what is the CONFIRMATORY test for megaloblastic anemia ? Bone marrow?

[@MedicosisPerfectionalis]

+Alamin Almughrabi Yes, bone marrow biopsy is the confirmatory test showing macro-ovalocytes and hypersegmented neutrophils. It may be important to confirm or rule out myelodysplastic syndrome (MDS), because it gives high MCV as well.

[@alaminmughrabi84]

Medicosis Perfectionalis Thanks Doctor for your help 🤗🤗🤗

[@MedicosisPerfectionalis]

+Alamin Almughrabi Don’t mention it...I am still a student by the way :) ...Good luck

[@neroetal]

@@MedicosisPerfectionalis you will for sure make the best doctor i the present century

[@beverleydawkins7929]

2.5

[@Noor-jw2tn]

Eye opening

[@MedicosisPerfectionalis]

👍

[@sofiaahmed3872]

2020/9/2

[@linzi6778]

I have B12 and folate ifound out a week ago but my doctors have failed to inform me or offer me 💉 none diet related x

[@diegoezeith3044]

So i need mora stomach acid to have a good gut?? And how i do that

[@MedicosisPerfectionalis]

There’s no way to increase it. You already have enough (unless you have achlorhydria)

[@SueAi7]

Diego Ezeith apple cider vinegar will do it

[@TheJimmyswe150]

@@MedicosisPerfectionalis what are you talking about? There are loads of things to increase stomach acid, Hcl betaine or acv are the main ones

[@TheJimmyswe150]

Betaine hcl or apple cider vinegar braggs

[@MedicosisPerfectionalis]

What hard evidence do you have?

[@Jesusiswatchingyou-123]

9-21

[@drsohailzahir2837]

❤❤❤

[@MedicosisPerfectionalis]

:)