Brief Answer:
symptomwise approach

Detailed Answer:
Dear
Thanks for contacting with your health concern and after reviewing the attached reports I’m of the following opinion:

1. Vitamin B12 and vitamin D3 are insufficient
2. Transferrin saturation and Iron range is low
3. Homocysteine range is high
4. You don’t have high cholesterol but it is borderline/desirable for which dietary regime and lifestyle changes are required at this moment
5. There is a slight increase in BUN/SR.Creatinine ratio but as your estimated eGFR value is normal so it couldn’t be due to renal cause but possibly pre-renal cause [dehydration] could be the culprit [as you were fasting]
6. All other reports are normal

A. As the deficiency is occurring at a young age [36 years] thus do let me know about the following:
- Decreased exposure to sunlight?
- Malabsorption [any celiac disease]? [take opinion from a Gastroenterologist]
- Overweight??
- Any endocrinal disorder with respect to thyroid/blood sugar is excluded from reports, so take an opinion from an endocrinologist [for any other pathology]

B. Any symptoms which you are experiencing like mood swings, bone pains, head sweating, gut disease?

C. Since your thyroid and eGFR is normal thus high homocysteine level could be due to low vitamin B12

D. Low Transferrin saturation suggests iron deficiency [so exclude chronic iron deficiency, chronic infection, any tissue inflammation, malignancy, uremia and nephrotic syndrome

PS. check with Serum ferritin level as it helps distinguish between iron deficiency anemia and anemia of chronic disease.

Do revert back with your concerns for further management and approach

Dr. Munish
Cosultant Physician
Naimittika

direct online link: bit.ly/drmunishsood

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