I have a high level of methylmalonic acid, 742, normal is 87-318. High indicates a vitamin B12 deficiency. This is a new one to me. What should I be looking for as symptoms? Did multiple myeloma cause this? Is it easy to correct?
The test results were posted online, and I have an appointment with my oncologist soon. I hope to have a basic understanding before, so I know what questions to ask.
I have been on Velcade, dex, and Revlimid for for forty-nine weeks. I hope this is a reaction to treatment, and not something else. Or "ain't" it much to worry about?
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h2omaker - Name: Tom
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 9/11/2006
- Age at diagnosis: 55
Re: Vitamin B12 deficiency - high methylmalonic acid (MMA)
Hello from Seattle H2Omaker,
Your doctor probably ordered the MMA because you are anemic and/or the size of your red blood cells is abnormal. The size of the red blood cells is reported on the CBC report as the MCV. This seems like a significantly elevated MMA but we need the level of your vitamin B12 to interpret it. You may have vitamin B12 deficiency (pernicious anemia), which is unrelated to multiple myeloma. It is also unrelated to chemotherapy.
Symptoms of B12 deficiency include tingling in the extremities or loss of sensation. This could be hard to interpret in someone getting Velcade because it can cause the same symptoms. If you do have vitamin B12 deficiency, it is easily fixed with a once per month injection of vitamin B12.
I would talk with your doctor about the interpretation of these tests. Thank you for contacting the Beacon with this question!
Your doctor probably ordered the MMA because you are anemic and/or the size of your red blood cells is abnormal. The size of the red blood cells is reported on the CBC report as the MCV. This seems like a significantly elevated MMA but we need the level of your vitamin B12 to interpret it. You may have vitamin B12 deficiency (pernicious anemia), which is unrelated to multiple myeloma. It is also unrelated to chemotherapy.
Symptoms of B12 deficiency include tingling in the extremities or loss of sensation. This could be hard to interpret in someone getting Velcade because it can cause the same symptoms. If you do have vitamin B12 deficiency, it is easily fixed with a once per month injection of vitamin B12.
I would talk with your doctor about the interpretation of these tests. Thank you for contacting the Beacon with this question!
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Vitamin B12 deficiency - high methylmalonic acid (MMA)
Thank you for your reply!
As always, the replies here are helpful.
My MCV is 104.6 and my RBC 3.61 has made a steady decline since starting the Velcade, dex, and Revlimid.
When I went in for my Velcade, the nurse cheerfully said "This is a two for one day for you!" I will be getting a weekly B 12 shot for the next four weeks in addition to my Velcade.
As always, the replies here are helpful.
My MCV is 104.6 and my RBC 3.61 has made a steady decline since starting the Velcade, dex, and Revlimid.
When I went in for my Velcade, the nurse cheerfully said "This is a two for one day for you!" I will be getting a weekly B 12 shot for the next four weeks in addition to my Velcade.
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h2omaker - Name: Tom
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 9/11/2006
- Age at diagnosis: 55
Re: Vitamin B12 deficiency - high methylmalonic acid (MMA)
Hello,
I'm a B12 deficient patient not a medical professional.
B12 is a coenzyme necessary in several metabolic pathways. On one of the pathways, it works with folate to enable homocysteine to be converted and utilized to enable DNA synthesis. If this does not occur in people with malabsorption issues (outside of those with dietary, infestation or surgical reasons), then you get cellular dysfunction. As a result of this cellular dysfunction the blood, being cells, is 'also' affected. Or at least it should be. In many cases it is not, for instance if there is a corresponding iron deficiency or the patient is consuming supplementary folate (folic acid).
The result is that cellular dysfunction continues to occur unobserved because, as has been stated, doctors are looking for anaemia. In many patients it never appears or appears very late in the illness progression.
On other metabolic pathways where B12 is required you end up with neurological degeneration also.
Problems regarding treatment occur due to misapprehensions regarding the disease progression which stem back many decades. It used to be believed that the anaemia was the cause of neuro degeneration and therefore that the anaemia came first - treat the blood and neuro degeneration would be prevented.
It was later discovered that the cellular/neuro damage was a cause of the anaemia, but the news didn't really seem to reach the masses. Hence today we have a situation where the anaemia is being treated as if it was the primary cause of the illness (and this is treated very quickly and easily), when in actual fact it is the last in the chain of events. So, patients get enough B12 to treat the blood, but not enough to reverse neuro and cellular degeneration.
I'm a B12 deficient patient not a medical professional.
B12 is a coenzyme necessary in several metabolic pathways. On one of the pathways, it works with folate to enable homocysteine to be converted and utilized to enable DNA synthesis. If this does not occur in people with malabsorption issues (outside of those with dietary, infestation or surgical reasons), then you get cellular dysfunction. As a result of this cellular dysfunction the blood, being cells, is 'also' affected. Or at least it should be. In many cases it is not, for instance if there is a corresponding iron deficiency or the patient is consuming supplementary folate (folic acid).
The result is that cellular dysfunction continues to occur unobserved because, as has been stated, doctors are looking for anaemia. In many patients it never appears or appears very late in the illness progression.
On other metabolic pathways where B12 is required you end up with neurological degeneration also.
Problems regarding treatment occur due to misapprehensions regarding the disease progression which stem back many decades. It used to be believed that the anaemia was the cause of neuro degeneration and therefore that the anaemia came first - treat the blood and neuro degeneration would be prevented.
It was later discovered that the cellular/neuro damage was a cause of the anaemia, but the news didn't really seem to reach the masses. Hence today we have a situation where the anaemia is being treated as if it was the primary cause of the illness (and this is treated very quickly and easily), when in actual fact it is the last in the chain of events. So, patients get enough B12 to treat the blood, but not enough to reverse neuro and cellular degeneration.
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Kayteetoo
4 posts
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