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Deficiência de folato

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 13 Sep 2025
Last updated: 21 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
Full details

Other diagnostic factors

  • diarreia prolongada
  • perda de apetite e perda de peso
  • fadiga
  • dispneia
  • tontura
  • palidez
  • cefaleia
  • taquicardia
  • taquipneia
  • sopro cardíaco
  • sinais de insuficiência cardíaca
  • sinais de abuso crônico de álcool
  • sinais de anemia hemolítica
  • sinais de dermatite esfoliativa
  • deglutição dolorosa
  • petéquias
  • glossite
  • estomatite angular
  • deficits neurológicos em crianças
Full details

Risk factors

  • baixa ingestão alimentar de folato
  • idade >65 anos
  • transtornos decorrentes do uso de bebidas alcoólicas
  • gestantes ou lactantes
  • prematuridade
  • síndromes de má absorção intestinal
  • uso de trimetoprima, metotrexato, sulfassalazina, pirimetamina ou anticonvulsivantes (por exemplo, fenitoína, fenobarbital)
  • ingestão infantil de leite de cabra
  • defeitos congênitos na absorção e no metabolismo do folato
  • estados de renovação celular elevada
  • ingestão de dietas especiais
  • diálise crônica
Full details

Diagnostic tests

1st tests to order

  • esfregaço de sangue periférico
  • Hemograma completo
  • contagem de reticulócitos
Full details

Tests to consider

  • folato sérico
  • folato eritrocitário
  • vitamina B12 sérica
  • lactato desidrogenase (LDH) sérico
  • bilirrubina sérica não conjugada
  • painel do ferro sérico
  • ácido metilmalônico sérico ou plasmático
  • homocisteína plasmática
  • aspirado/biópsia de medula óssea
Full details

Treatment algorithm

INITIAL

com risco de deficiência de folato em decorrência de gravidez ou lactação

com risco de deficiência de folato por causa de distúrbios de má absorção, distúrbio hemolítico crônico ou diálise crônica

com risco de deficiência de folato devido ao medicamento

ACUTE

adquirida: macrocitose sem anemia

adquirida: anemia macrocítica e pancitopenia

defeitos congênitos no metabolismo do folato

má absorção congênita do folato

deficiência congênita de transporte de folato cerebral

Contributors

Authors

Mark Koury, MD

Professor of Medicine, Emeritus (Hematology/Oncology)

Vanderbilt University Medical Center

Nashville

TN

Disclosures

MK declares that he has no competing interests.

Allison P. Wheeler, MD

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.

Mohammed Sika, PhD

Research Professor of Medicine (Nephrology)

Vanderbilt University Medical Center

Nashville

TN

Disclosures

MS declares that he has no competing interests.

Acknowledgements

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.

Disclosures

LVS and DM declare that they have no competing interests.

Peer reviewers

Ralph Green, MD, PhD, FRCPath

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.

Jack Metz, MB, BCh, MD, DSc(Med), FRCPath, FCAP, FRCPA, FRS(SA), DSc Med(Hon Caus)

Emeritus Professor and Consultant Haematologist

Dorevitch Pathology

Heidelberg

Victoria

Australia

Disclosures

JM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Pfeiffer CM, Sternberg MR, Zhang M, et al. Folate status in the US population 20 y after the introduction of folic acid fortification. Am J Clin Nutr. 2019 Nov 1;110(5):1088-97.Full text  Abstract

Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood Rev. 2006 Nov;20(6):299-318. Abstract

Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008 Jun;29(2 suppl):S20-34. Abstract

Whitehead VM. Acquired and inherited disorders of cobalamin and folate in children. Br J Haematol. 2006 Jul;134(2):125-36.Full text  Abstract

MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991 Jul 20;338(8760):131-7. Abstract

Institute of Medicine. Dietary reference intakes for thiamine, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press; 1998.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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