Folate deficiency laboratory findings: Difference between revisions
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First line investigations include the following: | First line investigations include the following: | ||
*Examination of peripheral blood smear : Macrocytic anemia and hypersegmented neutrophils are classically seen in folate deficiency. Anisocytosis and poikilocytosis can also be observed. | *Examination of peripheral blood smear : Macrocytic anemia and hypersegmented neutrophils are classically seen in folate deficiency. Anisocytosis and poikilocytosis can also be observed. | ||
*Complete Blood Count : Low hemoglobin, elevated MCV and MCH, thrombocytopenia, neutropenia. | *Complete Blood Count : Low hemoglobin, Low hematocrit, elevated MCV and MCH, thrombocytopenia, neutropenia. | ||
*Reticulocyte count : | *Reticulocyte count : | ||
{| | {| | ||
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| '''Erythrocyte Folic Acid''' || '''120-800 ug/l''' | | '''Erythrocyte Folic Acid''' || '''120-800 ug/l''' | ||
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[[MCV]] is often >110. [[Hematocrit]] can often be as low as 15. Elevated [[LDH]] and [[bilirubin]] are seen since dyserythopoesis leads to destruction of >90% of [[RBC]] precursors. Hypersegmentation of [[PMNs]] is quite sensitive (>5% with 5 or more lobes or >1% with 6 lobes). [[Reticulocyte]], [[WBC]] and [[platelets]] are low to normal. In one series of patients with [[B12 deficiency]], 64% had a [[MCV]] greater than 100, and only 29% had [[anemia]]. In general the [[blood film]] can point towards [[vitamin deficiency]]: | |||
* 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]]"). This is thought to be 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. | |||
** Ovalocytes (oval shaped RBCs) are present. | |||
* [[Bone marrow]] (not normally checked in a patient suspected of [[megaloblastic anemia]]) shows megaloblastic [[hyperplasia]]. | |||
* [[Howell-Jolly body|Howell-Jolly bodies]] ([[chromosomal]] remnant) also present. | |||
'''Blood chemistries will also show:''' | |||
* Increased [[homocysteine]] and [[methylmalonic acid]] in [[B12 deficiency]] | |||
* Increased [[homocysteine]] in [[folate]] defiency | |||
==References== | ==References== | ||
Revision as of 10:21, 28 January 2019
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Folate deficiency Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Laboratory Findings
First line investigations include the following:
- Examination of peripheral blood smear : Macrocytic anemia and hypersegmented neutrophils are classically seen in folate deficiency. Anisocytosis and poikilocytosis can also be observed.
- Complete Blood Count : Low hemoglobin, Low hematocrit, elevated MCV and MCH, thrombocytopenia, neutropenia.
- Reticulocyte count :
| 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 |
MCV is often >110. Hematocrit can often be as low as 15. Elevated LDH and bilirubin are seen since dyserythopoesis leads to destruction of >90% of RBC precursors. Hypersegmentation of PMNs is quite sensitive (>5% with 5 or more lobes or >1% with 6 lobes). Reticulocyte, WBC and platelets are low to normal. In one series of patients with B12 deficiency, 64% had a MCV greater than 100, and only 29% had anemia. In general the blood film can point towards vitamin deficiency:
- 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"). This is thought to be 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.
- Ovalocytes (oval shaped RBCs) are present.
- Bone marrow (not normally checked in a patient suspected of megaloblastic anemia) shows megaloblastic hyperplasia.
- Howell-Jolly bodies (chromosomal remnant) also present.
Blood chemistries will also show:
- Increased homocysteine and methylmalonic acid in B12 deficiency
- Increased homocysteine in folate defiency