u/onegirlcalledvan

Good morning!

I’m trying to make sense of this deficiency and what direction to go in. My PCP office has continued to be less than helpful…

Lab results:
* Vitamin B12: 175 pg/mL
* Vitamin D (25-OH): 27 ng/mL
* Ferritin: 23 ng/mL
* Iron saturation: 19%
* Folate: 5.7 ng/mL
* Methylmalonic acid (MMA): normal
* Homocysteine: 11.5 µmol/L
* Intrinsic Factor: Positive
* Antiparietal Cell Antibody: Negative

My PCP did one shot of cyanocobalamin 1000mcg weekly for 4 weeks. I don’t see him again until next Friday 8/28, but I will have gone 2+ weeks without injections by then and I feel TERRIBLE (fatigue/exhaustion, internally shaky, right leg tremor, heart palpitations at times, etc.)

Current supplements:
* Vitamin D3 + K2: D3 4,000 IU daily
* Iron: Iron Bisglycinate 25 mg elemental iron w/ vit C every other day
* Methylfolate: 400mcg (plan to work up to 5mg but trying to avoid anxiety)
* Omega-3: 2 ProOmega daily
* NAC: 600 mg twice daily
* Magnesium glycinate: 300mg before bed

I just ordered Hydroxocobalamin from a compounding pharmacy to SI and plan to inject 2-3x per week for 2 weeks at least.

I have a GI consult in early September and will have an endoscopy with biopsies.

Should I be seeing hematology? I feel like my PCP is very out of touch when it comes to B12 deficiency / pernicious anemia.

Thanks in advance for any feedback and suggestions!

Editing to add:

MTHFR genetic result was:
C677T: heterozygous — one variant copy
A1298C: heterozygous — one variant copy
(Compound heterozygous MTHFR C677T/A1298C)

B12 is 175 pg/mL. My functional NP recommended 3 B12 injections per week for 2 weeks as a loading dose, followed by 1 injection per week for 4–6 weeks. However, since she only sees me via telehealth, she suggested I follow up with my PCP to manage treatment.

My PCP recommended 1 injection per week for 4 weeks, followed by 1,000 mcg oral B12 daily, with a repeat B12 level in 6 weeks. I’m still waiting on my MMA result, and I’ve also asked to have intrinsic factor antibodies ordered. Had my first shot today at PCPs office - 1000 mcg cyanocobalamin.

I’m familiar with the NICE guidelines, but my PCP’s office said they follow a different “standard protocol” for B12 replacement.

For additional context, my iron studies showed ferritin 23 ng/mL, hemoglobin 11.8 g/dL, and iron saturation 19%. Despite that, they didn’t feel I needed iron supplementation.

I’ve been feeling absolutely awful and have developed neurological symptoms, including a right leg tremor, brain fog, tinnitus, low mood, fatigue, etc.

This is all new to me, but I’ve been digging into the literature and trying to understand the different treatment approaches. Given my B12 level and symptoms, does my PCP’s treatment plan seem conservative, or is it a reasonable approach? Should I push for a more aggressive loading regimen?

Thanks in advance for any input!