Folate

• occurs in most foods

  • esp. liver and green vegetables

• Daily requirement 100µg

• Body stores sufficient for 4 months

• deficiency causes megaloblastic anaemia

• related to Vitamin B12

Laboratory

• megaloblastic anaemia

• serum folate low

• serum B12 normal or slightly low

• to identify causes of malabsorption

  • antigliadin, antiendomysial antibodies

  • duodenal biopsy

Causes of deficiency

• Nutritional

  • old age

  • institutions

  • poverty

  • famine

• Malabsorption

  • Gluten-induced enteropathy

  • dermatitis herpetiformis

  • tropical sprue

• Excess utilisation

  • pregnancy

  • lactation

  • haematolytic anaemia

  • myelofibrosis

  • carcinoma

  • lymphoma

  • myeloma

  • Crohn's disease

  • rheumatoid arthritis

  • extensive psoriasis

  • exfoliative dermatitis

  • malaria

• Excess urinary loss

  • congestive heart failure

  • chronic dialysis

• Drugs

  • anticonvulsants

  • sulphasalzine

• Mixed

  • liver disease

  • alcoholism

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