Diagnosis
The diagnosis of folate deficiency anaemia is made by:
- clinical picture
- often the cause is dietary - may be associated with other factors such as chronic disease, alcoholism, pregnancy
- other causes include malabsorption, drugs, excessive utilisation of folate in malignancy, chronic well-compensated haemolysis (this may even occur with a normal haemoglobin level)
- take a detailed history - consider causes noted above - diet, drugs, alcohol, symptoms of malabsorption
- diagnosis of megaloblastic anaemia:
- FBC - macrocytic anaemia
- a thrombocytopaenia may occur secondary to ineffective megakaryopoiesis
- blood film - macrocytosis, hypersegmented neutrophils
- bone marrow - megaloblastic erythropoiesis, giant metamyelocytes
- measurement of red cell folate levels; a good index of long term status as opposed to plasma folate levels which indicate recent nutritional status
- also measure serum B12 levels and absorption - the other main cause of megaloblastic macrocytic anaemia
- anti-gliadin and anti-endomysial antibodies - this may reveal subclinical coeliac disease
- liver function tests other haematinics - if not already undertaken - a useful assessment of nutritional status
Reference
- Devalia V et al. The British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014 Aug;166 (4):496-513
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