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Macrocytic Anemia and high folate levels???

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Old 02-02-2011, 09:39 PM   #1
Join Date: Feb 2011
Location: San Luis Obispo
Posts: 3
Jephilli HB User
Macrocytic Anemia and high folate levels???

Hi all,

I thought I'd talk to people who might know more about this than I do! I am really, really confused about my results/what's going on!

So, I was just diagnosed with macrocytic anemia at my university's health center. These are my results from 1/18:

WBC: 5.1
RBC: 3.8
HGB: 13.1
HCT: 38.6
MCV: 102
MCH: 34.4

And all that other stuff on the list is normal.

They did more blood work on 1/26:

WBC: 4.0
RBC: 3.97
HGB: 13.7
HCT: 40.5
MCV: 102
MCH: 34.6

On this date, they also did something called a manual differential (WBC count, blood smear, microscopic examination with count)
Everything was normal on here except for:

Monocytes: 2

So, based on these results, the nurse practitioner said that I have macrocytic anemia.

A few days later, 1/28. I got a few other tests in order to see what was causing it:

Hepatic function panel:
Everything seems normal, except ALKPH (?) is low at 34.

Folate levels: >20 ng/mL...which is excessive.

B12: that's normal...

Blood count; reticulocyte, manual:

RBC: 4.0
Total Retics: 19.4 (it says this is low)

I originally went to my health center to have a rash looked at (apparently, it's pityriasis rosea...very annoying), and I get diagnosed with anemia! I've always had symptoms that seemed to relate to anemia...but didn't really do anything about it, since I haven't had health insurance for 10 years.

What's confusing me is my latest results, the one in which they checked my folate and B12 levels. When I took these tests I had eaten a large breakfast 2 hours before getting my blood drawn. I read that you should fast 8-10 hours before (after the fact). They knew I ate a large breakfast, and seemed to think it didn't matter, nor would it affect the results.

Yesterday, the nurse practitioner called me with my results. She told me everything seemed fine, concerning my thyroid and B12, but that my folate levels were really high. She said to stop taking my multi-vitamin and cut down on green leafy vegetables. I asked if a high level of folate could cause macrocytic anemia, and she said it could. From what I've researched, however, I've found no correlation. Except that high level can mask a B12 deficiency, or that my results were affected by the food I ate. I was skeptical by what she said, and got copies of all my results today.

If anyone can give me some insight on this, that'd be great, and I'd really appreciate it!

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Old 02-03-2011, 11:59 AM   #2
Junior Member
Join Date: Nov 2010
Location: USA
Posts: 22
daisygirly HB User
Re: Macrocytic Anemia and high folate levels???

not sure I can help at all....but I can say, I understand your frustration, I am in the same boat.
I am dx with B12 deficiency....but I have a very high folate level, and I have never taken a folate supplement. My is between 19-22. My most recent labs showed a low RBC 3.7, low Retic count 18700, and low hematocrit 35.
What is she looking at to dx you with anemia??
I read the same thing about high folate.

Old 02-03-2011, 03:07 PM   #3
Join Date: Feb 2011
Location: San Luis Obispo
Posts: 3
Jephilli HB User
Re: Macrocytic Anemia and high folate levels???

Daisygirly---from what I've researched a B12 deficiency does not sound fun at all. I'm sorry you're having frustrations with health as well. It's also strange that you've never taken a folate supplement. I just take a multi-vitamin, but it has 100% daily rec. of I guess that's too much for me, on top of my diet??

I'm curious, with your B12 deficiency, what is your MCV (Mean Corpuscular Volume) at? On my test, the range is 81-100 and mine are 102. Larger than normal MCV can indicate macrocytic anemia, specifically pernicious anemia with a B12 deficiency. From my understanding that should be treated asap!

I think the nurse practitioner I saw was looking at my MCV and RBC...not too sure. And if that's the case, then it seems it would be very mild anemia. It's still confusing to me. I wish they would bring out your numbers as they are diagnosing you, while explaining what makes them think you have anemia. I should have asked her to do me the facts while diagnosing me! I'm too much of a skeptic

Last edited by mod85; 10-08-2011 at 06:01 PM.

Old 09-20-2011, 09:17 AM   #4
Curious In TX
Join Date: Sep 2011
Location: Houston, TX USA
Posts: 4
Curious In TX HB User
Re: Macrocytic Anemia and high folate levels???

I have similar test results - high MCV, folate 19, b12 within normal ranges, low RBC, hematocrit, hemoglogin, etc. I thought it may be related to all my drugs, but my rheumatologist says no. My gastroenterologist has referred me to a hematologist, whom I see tomorrow. I'll let you know what he has to say.

Old 09-29-2011, 05:13 PM   #5
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Join Date: Sep 2010
Location: USA
Posts: 16
Jewelweed HB User
Re: Macrocytic Anemia and high folate levels???

Let's please keep this thread going! I'm sorry I don't have answers, but I'm in the same boat as you (low RBC count, high MCV, high folate, good B12). So far no doctor or message board or PubMed search has explained this phenomenon, nor even acknowledged that it exists! The few of us here are the first I've found with those lab parameters.

I wonder if we have other traits in common?

I'm a 28-year old active (runner) female, and my biggest complaints are coldness and fatigue.

Good luck to you and please keep us updated!

Old 10-02-2011, 05:35 PM   #6
Curious In TX
Join Date: Sep 2011
Location: Houston, TX USA
Posts: 4
Curious In TX HB User
Re: Macrocytic Anemia and high folate levels???

I went to a hemotologist a couple of weeks ago. My reticulocytes are high, but hemoglobin, hematacrit, etc. are low, MCV still high and he is thinking that this is an autoimmune process that I think he called microcytic anemia. He has a couple more tests he is running to confirm diagnosis, including 2 coombs tests. If those tests confirm what he suspects, he says we will watch my blood counts until they get low and then treat with high doses of steroids. Blood transfusions probably won't work due to numerous antibodies (which is what I believe the coomb tests will confirm). I'll keep you posted on status.

Old 10-08-2011, 06:00 PM   #7
Curious In TX
Join Date: Sep 2011
Location: Houston, TX USA
Posts: 4
Curious In TX HB User
Re: Macrocytic Anemia and high folate levels???

As an update, latest round of blood tests didn't pan out as the hematologist expected. Now I have to have a bone marrow biopsy next week and he's mentioning things like non-Hodgkins lymphoma and other lymphomas while he's patting my shoulder.

Old 10-23-2011, 09:37 AM   #8
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Join Date: Sep 2011
Location: Atlanta, GA
Posts: 38
Monetg98 HB User
Re: Macrocytic Anemia and high folate levels???

I was told I had Moderate Microcytic Anemia

Can anyone share their stories with be about Low Iron symptoms.... here are my numbers from Late august 2011 CBC:
RBC 4.68 (3.80-5.10)normal ranges
WBC 6.5 (4.0-10.5)normal ranges
Hemoglobin 9.3Low ((11.5 -15.0)normal ranges
Hematocrit 32.9Low (34 -44) normal ranges
MCV 70Low (80-98)normal ranges
MCH 19.9Low (27.0-34.0)normal ranges
MCHC 28.3Low (32.0-36.0)normal ranges
RDW 19.5High (11.7-15.0)normal ranges

Symptoms: Lightheadedness, weak/fatigue,easy excertion, dizziness, arm&hand tingling and slight numbness on and off in arms and hands. My thought process is foggy, sometimes i can not concentrate or think clearly, mild chest pain or palpitations. Doctors tell me im slightly anemic...but ive been told being slightly anemic is not the same as low iron. I would have to go to a hemotalogist to get the numbers on my iron count.
Doctors tell me I have vertigo because i am dizzy. Others say I have anxiety and panic disorder thats why im having all these symptoms. I dont think so! yes Im having anxiety and panic attacks, because I am stressed out and worrying about these symptoms! Im tired of feeling this way, and these regular doctors dont listen and I cant afford to go to a Hematologist until november! Can anyone shed some light please. Does low Iron stores cause all my symtoms. Also I have very heavy periods each month, Gushing blood on the first 36 -48 hours of my period, because of my fibroid. It was 5cm last March 2010. My entire cylce last 6-7days. No bleeding in between periods.
I took iron 325mg for late august and all of september 2011, once a day.

Old 10-25-2011, 09:57 AM   #9
Join Date: Oct 2011
Location: scotland uk
Posts: 1
alancl HB User
Re: Macrocytic Anemia and high folate levels???


High blood serum folate with megaloblastic anemia (low red count, high mcv, high mch) is due to a B12 deficiency.

B12 blood serum tests regularly show false negative results especially when accompanied with high folate and the real measure of B12 should be at tissue level and not what is pooled in the blood. Therefore the appropriate tests to determine B12 deficiency is a urine MMA (methylmalonic acid) and a Total Homocysteine test. These will be elevated when your body has a problem using B12 properly.

The reason you have high folate levels and megaloblastic anemia is because the body uses B12 and folate to produce red blood cells. Without the B12 your body cannot produce red blood cells properly and the outcome is less red cells and red cells that are produced are larger than normal (high mcv/mch). Your body uses folate in conjunction with B12 to make the red cells so when not enough red cells are being produced, less folate is needed, therefore there is an excess of unused folate pooling in your blood. You probably have a normal folate level but it cannot be used without the B12 so is left pooling in blood.

I would get your medical practitioner to check this out before the other things. I am not a doctor so any information that i've provided should not be relied upon and is for information only.

Hope this helps

Old 11-03-2011, 05:28 PM   #10
Curious In TX
Join Date: Sep 2011
Location: Houston, TX USA
Posts: 4
Curious In TX HB User
Re: Macrocytic Anemia and high folate levels???

I got back the results from my bone marrow biopsy - fortunately there were no lymphomas found. I have a hypoproliferative anemia and macrocytosis, consistent with refractory anemia. I gather from my doctors that since I have 2 chronic diseases (lupus and rheumatoid arthritis), I have an anemia common to chronic diseases. Thus, my rbc, hct, hgb, et al, will probably be low for the rest of my life and my MCV, RDW, MCHC, etc. will be high. Wbc count will either be low due to immuno-suppression or high if active infection. I guess if the counts get too low, a blood transfusion or steroids? My iron was high but apparently is being stored in my marrow and there was no evidence of iron sideroblasts (I think "sideroblast" means your body isn't properly doing something with the iron).

By the way, definitely avoid a bone marrow biopsy if given the choice. Maybe all aren't as bad as what I experienced, but the doctor who performed the biopsy (not my hematologist) was too proud of and anxious to show off his new drill to another doctor in the room, that he didn't allow ANY time for the numbing med to take effect before he started drilling. Even when I told him I didn't think the anesthetic was working, he simply stated that yes it was and continued to drill away. Worst medical test I've ever had in my life.

Old 02-09-2012, 08:44 AM   #11
Join Date: Feb 2012
Location: Livonia, MI
Posts: 3
meme3 HB User
Re: Macrocytic Anemia and high folate levels???

Did you ever get an answer to your high MCV? I am in the same boat for 7 years now!

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