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Folate Deficiency Anaemia (Risk Factors (Alcoholic, Pregnant, Poverty,…
Folate Deficiency Anaemia
Pathophysiology
Have low body stores of around 4 months
May develop rapidly in patients who have both a poor intake and excess utilisation of folate
Type of megaloblastic anaemia
Causes
Increased demand e.g. pregnancy or increased cell turnover e.g. malignancy
Malabsorption e.g. coeliac disease
Poor intake e.g. poverty, alcoholics and elderly
Antifolate drugs e.g. methotrexate
Risk Factors
Alcoholic
Pregnant
Poverty
Crohn's or coeliac disease
Elderly
Clinical Presentation
May present with symptoms of anaemia e.g. pallor, fatigue, dyspnoea, anorexia and headache
Glossitis (red sore tongue) can occur
Patients may be asymptomatic
NO NEUROPATHY unlike B12 deficiency - how you can differentiate
Diagnosis
Serum and red cell folate is low
GI investigation e.g. small bowel biopsy to exclude occult GI disease
Blood count and film
RBC's are MACROCYTIC
Peripheral film shows oval macrocytes with hypersegmented neutrophil polymorphs with six or more lobes in the nucleus
Typical of megaloblastic
Serum bilirubin may be raised as result of ineffective erythropoiesis resulting in increased RBC breakdown
Treatment
Treat underlying cause
Give FOLIC ACID tablets daily for 4 months - NEVER WITHOUT B12!