Anemia

Folate Deficiency

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Folate Deficiency, Folic Acid Deficiency

  • Epidemiology
  1. Rare in the United States due to fortified cereals
  • Causes
  1. Inadequate Folate intake
    1. Alcohol Abuse
    2. Elderly
    3. Vegan Diet
  2. Increased Folate utilization
    1. Pregnancy
    2. Malignancy
  3. Medications
    1. See Medications Affecting Folate Metabolism
  • Labs
  1. Complete Blood Count
    1. See Hemoglobin Cutoffs for Anemia
    2. See Hematocrit Cutoffs for Anemia
    3. Macrocytic Anemia (Mean Corpuscular Volume >100 um^3)
      1. MCV cutoff varies by age and per reference
  2. RBC Folate decreased
    1. Not the same as Serum Folate, which fluctuates considerably with diet
  3. Serum Vitamin B12 normal
  • Management
  1. Do not initiate Folate until B12 Deficiency ruled-out
    1. Folate supplementation masks B12 Deficiency
    2. Neurologic B12 Deficiency sequelae will progress
  2. Folic Acid 1 mg orally daily for 3 weeks or until resolved