Vitamin B9 deficiency: Difference between revisions
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==Background== | ==Background== | ||
*Also known as folate, folic acid | *Also known as [[folate]], folic acid | ||
*Necessary for normal erythropoiesis, purine and thymidylate synthesis, amino acids metabolism, and histidine metabolism | *Necessary for normal erythropoiesis, purine and thymidylate synthesis, amino acids metabolism, and histidine metabolism | ||
*Found in most fruits and vegetables | *Found in most fruits and vegetables | ||
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===Causes=== | ===Causes=== | ||
*Most common cause of deficiency is inadequate dietary intake, usually secondary to: | *Most common cause of deficiency is inadequate dietary intake, usually secondary to: | ||
**Chronic alcohol abuse | **Chronic [[alcohol Abuse|alcohol abuse]] | ||
**Anorexia | **[[anorexia nervosa|Anorexia]] | ||
**Inadequate or overcooked fruit/vegetable intake | **Inadequate or overcooked fruit/vegetable intake | ||
*Other causes: | *Other causes: | ||
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**Increased requirement | **Increased requirement | ||
***Chronic [[hemolytic anemia]] | ***Chronic [[hemolytic anemia]] | ||
***Pregnancy | ***[[Pregnancy]] | ||
***Exfoliative skin disorders | ***Exfoliative skin disorders | ||
**Folate loss due to hemodialysis | **Folate loss due to [[hemodialysis]] | ||
**Inhibition of reduction to active form (tetrahydrofolic acid) by [[methotrexate]] | **Inhibition of reduction to active form (tetrahydrofolic acid) by [[methotrexate]] | ||
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==Evaluation== | ==Evaluation== | ||
*CBC | *CBC | ||
**Macrocytic anemia (MCV>100 fL) | **Macrocytic [[anemia]] (MCV>100 fL) | ||
**RDW high | **RDW high | ||
**Hypersegmented neutrophils | **Hypersegmented neutrophils | ||
Revision as of 17:03, 29 September 2019
Background
- Also known as folate, folic acid
- Necessary for normal erythropoiesis, purine and thymidylate synthesis, amino acids metabolism, and histidine metabolism
- Found in most fruits and vegetables
- Recommended daily intake: 400 mcg or 500-600mcg if pregnant or lactating
- Total body stores of folate enough to supply requirements for 2–3 mo
Causes
- Most common cause of deficiency is inadequate dietary intake, usually secondary to:
- Chronic alcohol abuse
- Anorexia
- Inadequate or overcooked fruit/vegetable intake
- Other causes:
- Decreased absorption
- Tropical sprue
- Drugs (phenytoin, sulfasalazine, trimethoprim-sulfamethoxazole
- Increased requirement
- Chronic hemolytic anemia
- Pregnancy
- Exfoliative skin disorders
- Folate loss due to hemodialysis
- Inhibition of reduction to active form (tetrahydrofolic acid) by methotrexate
- Decreased absorption
Clinical Features
- Signs/symptoms of anemia which may be severe
- Glossitis
- Vague GI disturbances (e.g. anorexia, diarrhea)
- No neurologic features (unlike B12 deficiency)
Differential Diagnosis
Anemia
RBC Loss
RBC consumption (Destruction/hemolytic)
- Hereditary
- Acquired
- Microangiopathic Hemolytic Anemia (MAHA)
- Autoimmune hemolytic anemia
Impaired Production (Hypochromic/microcytic)
- Iron deficiency
- Anemia of chronic disease
- Thalassemia
- Sideroblastic anemia
Aplastic/myelodysplastic (normocytic)
Megaloblastic (macrocytic)
- Vitamin B12/folate deficiency
- Drugs (chemo)
- HIV
Evaluation
- CBC
- Macrocytic anemia (MCV>100 fL)
- RDW high
- Hypersegmented neutrophils
- Red blood cell folate level < 150 ng/mL
Management
- Folate: up to 1mg IV/IM or PO daily
- Maintenance: 0.4mg/day PO (non-pregnant/lactating) or 0.8mg/day PO (pregnant or lactating)