Folate deficiency laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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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

• 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.
• 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:

• Elevated serum LDH and indirect biluribin level
• Low serum folate level, usually <2.5ng/ml
• Low RBC folate level
• Increased homocysteine in folate deficency