Summary
Definition
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
- 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
1st investigations to order
- peripheral blood smear
- CBC
- reticulocyte count
Investigations to consider
- serum folate
- red blood cell 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
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 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 topic. LVS and DM declare that they have no competing interests.
Peer reviewers
Professor and Chair
Department of Pathology and Laboratory Medicine
University of California Davis School of Medicine
Sacramento
CA
Disclosures
RG is the author of reference(s) cited in this topic.
Emeritus Professor and Consultant Haematologist
Dorevitch Pathology
Heidelberg
Victoria
Australia
Disclosures
JM declares that he has no competing interests.
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