Summary
Definition
Megaloblastic anemia without neuropathy is the classic manifestation of folate deficiency.
[1]
Folate, a B vitamin, is present in natural foods such as green vegetables, legumes, and some fruits. Deficiency arises due to malabsorption, drugs and toxins, increased demand, or dietary deficiency.
[Figure caption and citation for the preceding image starts]:
Megaloblastic macrocytic anemia
From the personal collection of Fauzia Rana, MD, FACP
[Citation ends].
History and exam
Other diagnostic factors
- prolonged diarrhea
- headache
- loss of appetite and weight loss
- fatigue
- shortness of breath
- dizziness
- pallor
- tachycardia
- tachypnea
- heart murmur
- signs of heart failure
- signs of chronic alcohol abuse
- signs of hemolytic anemia
- signs of exfoliative dermatitis
- painful swallowing
- petechiae
- glossitis
- angular stomatitis
- neurologic deficits in children
Risk factors
- -6 low dietary folate intake
- age >65 years
- alcoholism
- pregnant or lactating
- prematurity
- intestinal malabsorptive disorders
- use of trimethoprim, methotrexate, sulfasalazine, pyrimethamine, or anticonvulsants (e.g., phenytoin, phenobarbital)
- 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
Investigations to consider
- serum folate
- RBC folate
- serum vitamin B12
- serum LDH
- serum unconjugated bilirubin
- serum iron panel
- plasma or serum methylmalonic acid
- plasma homocysteine
- bone marrow aspirate/biopsy
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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