Folate deficiency laboratory findings: Difference between revisions
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{{Folate deficiency}} | {{Folate deficiency}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Laboratory tests used to diagnose Folate deficiency include complete blood count, peripheral smear, serum LDH level, serum indirect biluribin level, serum folate level, RBC folate level, plasma or serum [[homocysteine]] level.<ref name="Snow1999">{{cite journal|last1=Snow|first1=Christopher F.|title=Laboratory Diagnosis of Vitamin B12 and Folate Deficiency|journal=Archives of Internal Medicine|volume=159|issue=12|year=1999|pages=1289|issn=0003-9926|doi=10.1001/archinte.159.12.1289}}</ref><ref name="pmid10386505">{{cite journal| author=Snow CF| title=Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician. | journal=Arch Intern Med | year= 1999 | volume= 159 | issue= 12 | pages= 1289-98 | pmid=10386505 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10386505 }}</ref> | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
First line investigations include the following: | |||
* Complete blood count: | |||
** Decreased [[hemoglobin]] and hematocrit levels | |||
** Increased [[mean corpuscular volume]] (MCV >95 fl often >110) and [[mean corpuscular hemoglobin]] (MCH) | |||
** Low corrected reticulocyte count which indicates decreased production by the bone marrow. | |||
** The [[platelet]] count may be reduced. | |||
* Examination of peripheral blood smear : | |||
** [[Neutrophil granulocyte|Neutrophil granulocytes]] may show multisegmented nuclei ("senile [[neutrophil]]"), due to decreased production and a compensatory prolonged lifespan for circulating [[neutrophils]]. | |||
** [[Anisocytosis]] (increased variation in [[RBC]] size) and [[poikilocytosis]] (abnormally shaped RBCs). | |||
** Macrocytes (larger than normal [[RBCs]]) are present. | |||
{| | {| | ||
|-style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| '''Reference Range''' || | | '''Reference Range''' || | ||
|-style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| '''Folic Acid in Serum/Plasma Deficiency''' || '''3.6-15 mg/dl''' | | '''Folic Acid in Serum/Plasma Deficiency''' || '''3.6-15 mg/dl''' | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| '''Adequate Folic Acid Supply''' || '''> 4 ug/l''' | | '''Adequate Folic Acid Supply''' || '''> 4 ug/l''' | ||
|-style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| '''Erythrocyte Folic Acid''' || '''120-800 ug/l''' | | '''Erythrocyte Folic Acid''' || '''120-800 ug/l''' | ||
|} | |}'''Blood chemistries will also show:''' | ||
* Elevated serum LDH and indirect biluribin level | |||
* Low serum folate level, usually <2.5ng/ml, suggestive of acute changes in folate level<ref name="pmid24942828">{{cite journal| author=Devalia V, Hamilton MS, Molloy AM, British Committee for Standards in Haematology| title=Guidelines for the diagnosis and treatment of cobalamin and folate disorders. | journal=Br J Haematol | year= 2014 | volume= 166 | issue= 4 | pages= 496-513 | pmid=24942828 | doi=10.1111/bjh.12959 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24942828 }}</ref> | |||
* Low RBC folate level, reflect long term folate status | |||
* Increased [[homocysteine]] in [[folate]] <ref name="pmid10926922">{{cite journal| author=Klee GG| title=Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate. | journal=Clin Chem | year= 2000 | volume= 46 | issue= 8 Pt 2 | pages= 1277-83 | pmid=10926922 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926922 }}</ref> | |||
Some investigations done to rule out the other causes of megaloblastic anemia include: | |||
*serum vitamin B12 | |||
*serum iron panel | |||
*plasma or serum methylmalonic acid<ref name="pmid109269222">{{cite journal| author=Klee GG| title=Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate. | journal=Clin Chem | year= 2000 | volume= 46 | issue= 8 Pt 2 | pages= 1277-83 | pmid=10926922 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926922 }}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
{{WS}} | |||
{{WH}} | |||
Latest revision as of 03:50, 17 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory tests used to diagnose Folate deficiency include complete blood count, peripheral smear, serum LDH level, serum indirect biluribin level, serum folate level, RBC folate level, plasma or serum homocysteine level.[1][2]
Laboratory Findings
First line investigations include the following:
- Complete blood count:
- Decreased hemoglobin and hematocrit levels
- Increased mean corpuscular volume (MCV >95 fl often >110) and mean corpuscular hemoglobin (MCH)
- Low corrected reticulocyte count which indicates decreased production by the bone marrow.
- The platelet count may be reduced.
- Examination of peripheral blood smear :
- Neutrophil granulocytes may show multisegmented nuclei ("senile neutrophil"), due to decreased production and a compensatory prolonged lifespan for circulating neutrophils.
- Anisocytosis (increased variation in RBC size) and poikilocytosis (abnormally shaped RBCs).
- Macrocytes (larger than normal RBCs) are present.
| Reference Range | |
| Folic Acid in Serum/Plasma Deficiency | 3.6-15 mg/dl |
| Adequate Folic Acid Supply | > 4 ug/l |
| Erythrocyte Folic Acid | 120-800 ug/l |
Blood chemistries will also show:
- Elevated serum LDH and indirect biluribin level
- Low serum folate level, usually <2.5ng/ml, suggestive of acute changes in folate level[3]
- Low RBC folate level, reflect long term folate status
- Increased homocysteine in folate [4]
Some investigations done to rule out the other causes of megaloblastic anemia include:
- serum vitamin B12
- serum iron panel
- plasma or serum methylmalonic acid[5]
References
- ↑ Snow, Christopher F. (1999). "Laboratory Diagnosis of Vitamin B12 and Folate Deficiency". Archives of Internal Medicine. 159 (12): 1289. doi:10.1001/archinte.159.12.1289. ISSN 0003-9926.
- ↑ Snow CF (1999). "Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician". Arch Intern Med. 159 (12): 1289–98. PMID 10386505.
- ↑ Devalia V, Hamilton MS, Molloy AM, British Committee for Standards in Haematology (2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". Br J Haematol. 166 (4): 496–513. doi:10.1111/bjh.12959. PMID 24942828.
- ↑ Klee GG (2000). "Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate". Clin Chem. 46 (8 Pt 2): 1277–83. PMID 10926922.
- ↑ Klee GG (2000). "Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate". Clin Chem. 46 (8 Pt 2): 1277–83. PMID 10926922.