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Calcium (thanks for reply in previous Q)
d3 & b12 levels (as mentioned in previous Q's) were 5.58 and 132 respective & after consultation already started medicine ! doctor's often told me to share other results as well so Cbc shows I have macrocytic (megaloblastic) anemia...(RBC MERELY 3.33M) TSH - normal i.e 3.375 Whereas there was a conflict in HbA1c and Fasting i.e 4.1 and 106.1 respectively... Lipid profile - everything normal... Lft - sgpt slightly high i.e 49.4 and sgot (33.9 is normal) and even total , direct and indirect bilirubin were slightly high i.e 1.58 , 0.32 and 1.26 respective...(Although I don't consume alcohol) Kft - bun , urea & creatinine are low i.e 6.9 , 14.77 and 0.49 respectively (Calcium was found normal i.e 9.5 but I am suffering from bone and joint pain) Iron studies - %TS = 46.04%(slightly high) Borderline normal magnesium i.e 2.04 and normal zinc i.e 103.5... Tests not mention are "NORMAL" I don't consume dairy so do I need calcium 💊 for bones ? Consuming calcium 💊 at 18 is safe or not ?
Answers (26)
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Your reports suggest that the main issue is severe Vitamin D deficiency (5.58) and low Vitamin B12 (132), which explains:
Bone and joint pain
Macrocytic (megaloblastic) anemia
Mild indirect bilirubin elevation (can occur with B12 deficiency due to ineffective erythropoiesis)
Your calcium level (9.5) is normal, so the pain is not due to low serum calcium. In fact, in Vitamin D deficiency, calcium can remain normal initially because the body compensates using parathyroid hormone.
At 18 years of age, routine calcium supplementation is not mandatory if your dietary intake is adequate. The recommended daily intake at your age is around 1000 mg/day (from diet + supplements combined).
Next Steps
However, the priority right now is:
Correcting Vitamin D deficiency (usually 60,000 IU weekly for 6–8 weeks)
Correcting B12 deficiency (oral or injectable depending on severity)
Health Tips
Once Vitamin D improves, bone pain usually reduces significantly even without heavy calcium supplementation.
So focus first on D3 and B12 correction. Calcium can be added if dietary intake is poor, but high doses are not required.
Follow up after 8–12 weeks with repeat levels.
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After seeing complete reports you are having severe d3 deficiency and mild b12 deficiency.This d3 deficiency causes bone and joint pain and b12 causes megaloblastic anemia.
As you are 18 years old you won’t need calcium supplements as of now because your serum calcium level is normal- you can take calcium if bone and joint pain pain still exists during vit d therapy
Regarding liver changes - these enzymes are mildly affected most probably due to ineffective erythropoiesis which is the production of rbc’s halted due to b12 deficiency or there is mild hemolysis.It will revert to normal if these deficiencies were corrected
Next Steps
-cholecalciferol 60000IU weekly for 4 weeks repeat d3 after 4 weeks
-eat green leafy vegetables,liver meat,fruits,curd,milk
-expose to early morning or late evening sunlight for about 15 to 20 minutes
-consume any multivitamin tablets for 3 to 4 weeks
-have balanced nutrition including carbohydrates,proteins,vitamins and fat in correct ratios
Health Tips
For further consultation reach me on practo anytime
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If you are having symptoms, you can take VitB12 injection IM 1000mcg alternative days for 2 week.
Take Divion 60k once a week
Take calykD3 tab OD
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Continue same treatment, repeat tests for calcium, vit d3, Haemoglobin, after 6 weeks.
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All these point towards vit b12 deficiency leading to megaloblastic anemia and Vit D3 deficiency as well . I would recommend you to continue your treatment for 6-8 weeks and repeat all the lab tests after 6 weeks to see your progress
Next Steps
continue your treatment
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Please consult for thorough evaluation and guidance.
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Macrocytic picture is seen in severe vitamin b 12 deficiency.If you are symptomatic,you can take injection cyanocobalamin 1000 mcg alternate days for 2-3 weeks , followed by oral tablet.Continue with the medicine for vitamin d deficiency.You can take calcium supplement 600 mg once a day
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You need proper evaluation. Joint pain , anaemia in your age needs to be taken seriously and needs further testing for rheumatoid arthritis/ other connective tissue disorder.
Next Steps
kindly consult
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If you want to discuss your problem in more detail, feel free to message me on WhatsApp at nine one one nine two five five six nine nine for a detailed free discussion
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Your reports show a clear nutritional pattern, not something malignant.
Key findings:
• Vitamin D3 = 5.58 ng/mL → Severe deficiency
• Vitamin B12 = 132 pg/mL → Deficient
• RBC = 3.33 million → Low
• Macrocytic (megaloblastic) anemia → Consistent with B12 deficiency
• TSH normal (3.375)
• HbA1c 4.1 with fasting glucose 106 → HbA1c falsely low is common in anemia
• SGPT 49.4 → Mildly elevated (can be due to fatty liver or B12 deficiency)
• Bilirubin mildly elevated → Possibly indirect rise from ineffective erythropoiesis
• KFT values low → Usually not clinically concerning at your age
• % Transferrin saturation slightly high → Seen in B12-related anemia
Your bone and joint pain is most likely due to severe Vitamin D deficiency, not low calcium (calcium is normal).
This picture strongly fits:
➡️ Severe Vitamin D deficiency
➡️ Vitamin B12 deficiency
➡️ Megaloblastic anemia secondary to B12
No red flags for cancer based on the data provided.
Next Steps
✔ Continue prescribed Vitamin D therapy (usually high-dose weekly for 6–8 weeks)
✔ Start/continue B12 replacement (oral or injections depending on severity)
✔ Repeat CBC + B12 after 6–8 weeks
✔ Check serum ferritin once (to rule out mixed deficiency)
Regarding calcium:
• Your serum calcium = 9.5 (normal)
• At 18 years, calcium supplementation is safe if required
• If dietary intake is poor (no dairy), 500–600 mg daily is reasonable
But correcting Vitamin D is more important than adding calcium immediately.
Health Tips
✔ Sun exposure 20 minutes daily (morning sunlight)
✔ Include plant calcium sources (sesame seeds, ragi, almonds, leafy greens)
✔ Take Vitamin D with a fatty meal
✔ Avoid tea/coffee around B12 intake
✔ Recheck liver enzymes after vitamin correction
Most of your abnormalities are interconnected and nutritional — and reversible.
To optimise your correction plan properly (dose calculation, duration, monitoring strategy, and bone pain management), I recommend booking an online consultation so we can create a structured recovery plan instead of treating values in isolation.
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Your calcium level is normal, so extra calcium is not compulsory right now. Main issue is low Vitamin D and B12, continue those medicines.
Bone pain is likely from Vitamin D deficiency. Calcium at your age is safe if needed, but only in proper dose.
Please consult me for proper dose and complete treatment plan.
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Hello,
From your reports, the main issue appears to be Vitamin B12 deficiency with macrocytic (megaloblastic) anemia, which itself can cause weakness, bone and joint pain, and mild bilirubin rise. Your calcium level is normal (9.5), so currently there is no evidence of calcium deficiency. Slightly elevated SGPT and bilirubin can also be seen in B12 deficiency and usually improve after treatment.
Since you don’t consume dairy, dietary calcium intake may be lower, but supplementation should be based on need, not just symptoms.
Next Steps
What you can do next:
• Continue Vitamin B12 and Vitamin D treatment as prescribed.
• Check Vitamin D level if not done.
• Repeat CBC and LFT after 6–8 weeks of treatment.
• Ensure adequate dietary calcium (plant sources like sesame seeds, ragi, almonds, green leafy vegetables).
• Start calcium supplement only if dietary intake is insufficient or Vitamin D is low.
Health Tips
Healthy tips:
• Include protein-rich foods regularly.
• Get 15–20 minutes of sunlight exposure daily.
• Avoid self-medicating high-dose supplements unnecessarily.
• Maintain balanced diet and proper sleep.
Taking calcium at 18 years or now is generally safe in proper doses, but since your calcium is normal, it’s better to correct B12 and Vitamin D first. If you’d like, I can guide you on the right dose based on your Vitamin D level and diet pattern.
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Dr. Gaurav Jaiswal
General Physician
6 yrs exp
Jhansi
Kindly do connect and consult
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Consult
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Dr. Shahbaz Khan
General Physician
4 yrs exp
Delhi
Please take a consultation before taking advice
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Dr. Nazia Begum M.G
General Physician
15 yrs exp
Belgaum
Start calcimax 500 daily
It's safe continue
Take food Rich in iron calcium
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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Dr. Anuj Mothsra
General Physician
6 yrs exp
Jhunjhunu
Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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Dr. Anusha P
General Physician
1 yrs exp
Bangalore
Detailed evaluation needed
Next Steps
kindly consult
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Dr. Sajid Ali
General Practitioner
4 yrs exp
Kanpur
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Dr. Suraj Sharma
General Practitioner
4 yrs exp
Jaipur
Do consult
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Dr. Kamal Kumar
General Physician
7 yrs exp
Rewari
Dear Patient
Your reports show very low Vitamin D (5.5) and low B12 (132) with megaloblastic anemia, which explains your bone pain, weakness, and low RBC count. This condition is common and treatable.
Since you do not consume dairy, taking calcium is safe and recommended at your age (18 years). You can take:
• Calcium 500–600 mg + Vitamin D once daily after meals
• Continue prescribed Vitamin D and B12 supplements regularly
Bone and joint pain usually improve within 6–8 weeks after levels start correcting. There is nothing dangerous in your reports, but regular treatment is important.
If symptoms persist, repeat levels after 2–3 months.
You also text me for prescription
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