Just got back from my one year post op appt. Few questions regarding labwork

So I was exactly 12 months post op July 27,2013! I am down a total 121 lbs and my bmi went from 41 to 24 Also I am now wearing size 8 pants and med shirt instead of size 24 pants and 3Xl shirt. Anyways I was told all my labs were "normal" but I still insisted on getting a report ( thanks to poet Kelly). When I read the report a few things came back flagged. They are as follows...vitamin b12 170 normal 193-986
Folate. 19.1. normal 3.1-17.5
Bilirubin 2.4. normal .2-1.0
WBC. 3.1. normal 4.4-11.3
RBC. 2.97. normal 4.10-5.10
MCHC. 31.1. normal 33.4-35.5
Zinc. 58. normal 60-120
My Dr doesn't seem to concerned but should I follow up with somebody else or just let it go?

I can tell you about the vitamins.  Talk to your doc about the WBC and RBC.

Your B12 is dangerously low.  Are you not exhausted?  Below 550, people generally get symptoms like fatigue, depression, trouble concentrating and poor short term memory.  Even more serious, below 400 you can get permanent nerve damage.  Do you have tingling in your hands and feet yet?

How much B12 have you been taking?  You need to increase that ASAP.

Your folate is fine.

Your zinc is a little low, so I would add a little zinc to your vitamin routine.

What vitamins are you currently taking?  Are you taking a B-complex, that would shed some light on the higher than range folate.  It could also indicate pernicious anemia, what is your B-12 level?

You also don't show TBIC, Iron Saturation, Iron and Ferritin.  Do you take iron?  I would want these other test if they weren't taken it could be you are experiencing some iron deficiency anemia and need to be referred to a hematologist. 

Edit:  Sorry I just noticed the B-12 and it's low, dangerously low IMO.  Are you feeling any of these symptoms? 

 

• weakness, tiredness or light-headedness  
• rapid heartbeat and breathing
• pale skin
• sore tongue
• easy bruising or bleeding, including bleeding gums
• stomach upset and weight loss
• diarrhea or constipation

If the deficiency is not corrected, it can damage the nerve cells. If this happens, vitamin B12 deficiency effects may include:

• tingling or numbness in fingers and toes
• difficulty walking
• mood changes or depression
• memory loss, disorientation, and dementia

I'd definitely pursue the concerns you have.  You may need to get B-12 injections to bring your levels up quicker.  Who did you discuss your labs with, your surgeon or PCP? 

Thanks for your quick replies. Yes I have been experiencing ALL of those symptoms. I have been so tired I take 2 naps a day! It's to the point where I don't even want to get out of bed I went over the labs with my surgeon but maybe I will make an appt with my pcp. I have been taking all the vitamins my surgeon recommends and the b12 I take is sublingual.

How much B12?  What's the dose? 

As seriously low as yours is, I would ask your doc to prescribe B12 shots and do them weekly for a couple months.  Then you shoudl be able to cut back to every other week for a couple months, and maybe down to  once a month after that.  If you don't want to do shots, I would get the biggest dose of sublingual you can find, like 5000 mcg, and take it daily.

I bet you are exhausted.  That's the lowest B12 I've seen so far, and lots of people show me their labs.  I would imagine you are so tired you can barely stand up.  I would also imagine you are super forgetful right now.  With B12 that low, I would expect you to be feeling pretty crappy.

The good news is, it doesn't take long to get your B12 level back up and get some more energy.

Zinc is something not everyone needs extra of.  Mine was slightly low at one point and I now take 50 mg zinc twice a week and it keeps my level good.  I recently bought the Sundown brand of zinc (found it at Kroger but lots of stores carry it) and I forget what it cost but it was really cheap, and since I just take it twice a week, one bottle will last me almost a year.

Some of the exhaustion will be due to just having surgery and recovering; however, you really do need to discuss these levels with your PCP if your surgeon isn't concerned.  If it were me I'd up my sublingual B-12 until I could get in to discuss my levels, what isn't used you'll pee out.  I keep my B-12 above 1000 preferably above 1200 (but this is just me)

How much B-12 are you currently taking?

I suspect you are NOT taking a sublingual B12 at the moment, and so would go out NOW!!!! and buy some and start taking the highest dose you can find (5000 mcg at least ) at least twice per day.   Make sure they dissolve under your tongue.

170 is a dreadful level and needs to be rectified as soon as possible ...  like, TODAY!

Arrange to see a haematologist and have the level rechecked then (or within 14 days) to ensure your level is rising ...   Ideally it should be over 1000 for you to remain healthy and most RNY'ers can achieve this with sublinguals, although some do chose B12 shots once a month ...

ETA:  just saw your post saying you take sublingual B12s - you are dissolving them completely under your tongue?  Can't see why your levels are so low if you are taking them correctly every day???   Definitely need to see a haem!

The b12 I take is only 1000mcg and I was instructed to take it only once a week but maybe I will try once a day and see if that improves my levels. I am supposed to have my labs drawn again in 6 months.

It's not enough - this is serious - you are at risk of permanent nerve damage.  

Believe me, I have had pernicious anaemia for over 20 years (before RNY) and have irreparable damage because I wasn't diagnosed with this genetic auto immune disease.  

RNY is NOT the same as what I have, which is why I take shots (2mls) at least twice a week  and struggle to get a reasonable level, but RNY could give you the same problem with the lack of intrinsic factor.

If you don't believe me, please google it!