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Folate deficiency

Folate ( Vit B9 ) – water soluble vitamin Terms folic acid / folate – in nature found as folate whereas folic acid is the synthetic form available therapeutically Folate is absorbed in the terminal ileum and stored mostly in liver Found in abundance in fruits , green leafy vegetables and liver Important in formation of several co-enzymes in several metabolic systems particularly for purine and pyrimidine synthesis , nucleoprotein synthesis and maintenance of erythropoiesis Particularly important during periods of rapid cell division and growth as pregnancy & infancy Some nations have added folate to grains to avoid neural tube defects ( fortified )

 

dietary deficiency as alcoholism , veganism , low stores & intake by breastfed infants malabsorption ( gastric atrophy & malabsorption from food , pernicious anemia , ileal disease , chronic pancreatitis ) increased need for pregnancy and lactation ↑ requirement when peripheral red cell destruction occurs or abnormal hemopoiesis manifested by ↑ ed red cell requirements or thrombocytopenia e,g sickle cell disease and haemolytic anaemias antifolate medication use as cholestyramine , sulfasalazine , methotrexate parasitic infections haemodialysis.

 

Deficiency manifests 1st where rapid turn over of cell takes place as in bone marrow 
( megaloblastic anaemia ) and gastrointestinal tract ( glossitis )

 

No clear
 consensus what level
 indicates deficiency but risk of
 megaloblastic anaemia ↑↑ es at levels
 < 3 g/l ( 7 nmol/l ) , a sizable indeterminate zone exists between 3 – 4.5 g/l , hence low serum should be seen as suggestive of folate deficiency
 rather than a highly sensitive 
diagnostic test.

 

ensure B12 is normal before 
commencing Rx consider checking coeliac screen render dietary advice

 

Folic acid 5 mg / D x 4 
months -unless underlying cause is persistent. F/U bloods in 10 days – FBC / retics is recommended.

References

  1. Devalia, V., Hamilton, M.S., Molloy, A.M. and (2014), Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol, 166: 496-513.https://doi.org/10.1111/bjh.12959
  2. Chan, Yen-Ming et al. “Folate.”Advances in nutrition (Bethesda, Md.)vol. 4,1 123-5. 1 Jan. 2013, doi:10.3945/an.112.003392
  3. https://www.nwlondonccg.nhs.uk/application/files/9616/0405/1009/6._Folate_deficiency.pdf

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