Folate deficiency

Causes

Appropriate Tests

 

Full blood count, Blood film, (often pancytopenia; oval macrocytosis, neutrophil hypersegmentation); Folate, Vitamin B12 assay, if indicated.

Bone marrow biopsy (aspiration) is rarely required for diagnosis and/or confirmation.

Review clinical findings to determine likely cause.

Dietary deficiency

 

Alcoholism

 

Extremes of age - especially premature infants

 

Haemodialysis

 

Debilitating illness

 

Malabsorption especially

  • Coeliac disease
  • Jejunal resection

 

Jejunal resection

 

Drugs (may impair folate absorption), especially;

  • Anticonvulsants
  • Oral contraceptives

 

 

Folate - low serum folate but adequate RBC folate.

Increased requirements

 

Pregnancy

 

Malignancy (disseminated)

 

Haemolysis

 

Impaired utilisation

 

Alcoholism

 

Drugs, especially;

  • Methotrexate
  • Trimethoprim
  • Salicylazosulphapyridine