Folate deficiency laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory tests used to diagnose Folate deficiency include complete blood count, peripheral smear, serum LDH level, serum indirect biluribin level, serum folate level, RBC folate level, plasma or serum homocysteine level.[1][2]

Laboratory Findings

First line investigations include the following:

Reference Range
Folic Acid in Serum/Plasma Deficiency 3.6-15 mg/dl
Adequate Folic Acid Supply > 4 ug/l
Erythrocyte Folic Acid 120-800 ug/l

Blood chemistries will also show:

  • Elevated serum LDH and indirect biluribin level
  • Low serum folate level, usually <2.5ng/ml, suggestive of acute changes in folate level[3]
  • Low RBC folate level, reflect long term folate status
  • Increased homocysteine in folate [4]

Some investigations done to rule out the other causes of megaloblastic anemia include:

  • serum vitamin B12
  • serum iron panel
  • plasma or serum methylmalonic acid[5]

References

  1. Snow, Christopher F. (1999). "Laboratory Diagnosis of Vitamin B12 and Folate Deficiency". Archives of Internal Medicine. 159 (12): 1289. doi:10.1001/archinte.159.12.1289. ISSN 0003-9926.
  2. Snow CF (1999). "Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician". Arch Intern Med. 159 (12): 1289–98. PMID 10386505.
  3. Devalia V, Hamilton MS, Molloy AM, British Committee for Standards in Haematology (2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". Br J Haematol. 166 (4): 496–513. doi:10.1111/bjh.12959. PMID 24942828.
  4. Klee GG (2000). "Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate". Clin Chem. 46 (8 Pt 2): 1277–83. PMID 10926922.
  5. Klee GG (2000). "Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate". Clin Chem. 46 (8 Pt 2): 1277–83. PMID 10926922.

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