Folate Deficiency

Pathology:

Folate is an essential component of the process of DNA synthesis.

Aetiology:

Folate deficiency can be caused by inadequate intake or malabsorption of folate in the diet, increased utilization associated with rapid metabolic turnover, requirement for additional levels during pregnancy, and use of anti-folate drugs such as methotrexate.

Symptoms:

• Anaemia
• Neuropathy
• Bowel disease

Signs:

In some cases, there may be no discernible signs. However, pallor, congestive heart failure, peripheral neuropathy, confusion, and Sub-acute Combined Degeneration of the spinal cord may be seen.

Investigations:

• FBC, serum B12 and Folate levels should be tested in the blood.
• The blood film may show oval macrocytosis and hypersegmented neutrophils.
• Bone marrow biopsy, serum ferritin, LDH, and homocysteine levels may also be checked.

Treatment:

Once any deficiency of B12 has been corrected, replacement with folic acid can be administered.

Complications:

• Neural tube formation defects in pregnant women
• Sterility
• Cardiovascular disease

Prognosis:

When treatment is given, symptomatic relief can usually be seen within 24 hours. The overall prognosis is generally considered to be very good.