Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors

Other diagnostic factors

  • prolonged diarrhoea
  • headache
  • loss of appetite and weight loss
  • fatigue
  • shortness of breath
  • dizziness
  • pallor
  • tachycardia
  • tachypnoea
  • heart murmur
  • signs of heart failure
  • signs of chronic alcohol abuse
  • signs of haemolytic anaemia
  • signs of exfoliative dermatitis
  • painful swallowing
  • petechiae
  • glossitis
  • angular stomatitis
  • neurological deficits in children

Risk factors

  • low dietary folate intake
  • age >65 years
  • alcoholism
  • pregnant or lactating
  • prematurity
  • intestinal malabsorptive disorders
  • use of trimethoprim, methotrexate, anticonvulsants, sulfasalazine, or pyrimethamine
  • infantile intake of goats' milk
  • congenital defects in folate absorption and metabolism
  • states of increased cell turnover
  • intake of special diet
  • chronic dialysis

Diagnostic investigations

1st investigations to order

  • FBC
  • reticulocyte count
  • peripheral blood smear
Full details

Investigations to consider

  • serum folate
  • RBC folate
  • serum vitamin B12
  • serum lactate dehydrogenase (LDH)
  • serum unconjugated bilirubin
  • serum iron panel
  • plasma or serum methylmalonic acid
  • plasma homocysteine
  • bone marrow aspirate/biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine, Emeritus (Hematology/Oncology)

Vanderbilt University Medical Center

Nashville

TN

Disclosures

MK declares that he has no competing interests.

Assistant Professor of Pathology, Microbiology, and Immunology

Assistant Professor of Pediatrics (Pediatric Hematology-Oncology)

Vanderbilt University Medical Center

Nashville

TN

Disclosures

APW declares that she has no competing interests.

Research Associate Professor of Medicine (Nephrology)

Vanderbilt University Medical Center

Nashville

TN

Disclosures

MS declares that he has no competing interests.

Dr Mark Koury, Dr Allison Wheeler, and Dr Mohammed Sika would like to gratefully acknowledge Dr Lakshmi V. Srivaths and Donald Mahoney Jr., previous contributors to this monograph. LVS and DM declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor and Chair

Department of Pathology and Laboratory Medicine

University of California Davis School of Medicine

Sacramento

CA

Disclosures

RG is the author of 2 references cited in this monograph.

Emeritus Professor and Consultant Haematologist

Dorevitch Pathology

Heidelberg

Victoria

Australia

Disclosures

JM declares that he has no competing interests.

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