Folate deficiency

Causes of folate deficiency:

Inadequate intake (major cause)

Excess utilization (physiological):

• Pregnancy
• Lactation

Excess utilization (pathological):

• Excess RBC production (e.g. haemolysis)
• Malignancy
• Inflammatory disease
• Dialysis

Malabsorption:

• Small bowel disease

Antifolate drugs:

• Anticonvulsants (e.g. phenytoin)
• Methotrexate
• Trimethoprim

Clinical features:

• Asymptomatic
• Symptoms of anaemia
• Symptoms of the underlying cause
• Glossitis
• NEUROPATHY DOES NOT OCCUR

Investigations:

Haematological findings show a megaloblastic anaemia:

• MCV >96fl
• Macrocytosis
• Hypersegmented neutrophils (with >6 nuclear lobes)
• Leucopenia/thrombocytopenia if severe

Low serum folate

Treatment:

• 5mg of folic acid daily PO with an improvement in the clinical picture within 48 hours
• prophylactic folic acid (400μg) is recommended for all women planning a pregnancy