Anaemia - Folate Deficiency (Macrocytic Megaloblastic) Flashcards
Where is folate found?
Green vegetables e.g. spinach, broccoli, nuts, yeast + liver
Risk factors
Elderly
Poverty
Alcoholic
Pregnant
Crohn’s or coeliacs
Aetiology
Poor intake (MC)
- Poverty
- Alcoholic
- Elderly
(Goat milk + over cooking = Decrease folate)
Increased demand
- Pregnancy
- Increased cell turnover i.e., haemolysis, malignancy, inflammatory disease + renal dialysis
Malabsorption
- Coeliac
- Crohn’s
- Increased alcohol consumption
- Antifolate drugs i.e., methotrexate, trimethoprim
Pathophysiology
Absorbed by the duodenum/ proximal jejunum
Folate is also essential for DNA synthesis = delayed nuclear maturation = Large RBC + decreased production in the bone marrow
The DNA impairment will affect all cells, but bone marrow effected most due to most active in terms of cell division.
Folate essential for foetal development = deficiency can lead to neural tube defects
Signs and symptoms
Body stores for up to 4 months so no symptoms until then:
General anaemia signs
- Pallor
- Fatigue
- Dyspnoea
- Anorexia
- Headache
Glossitis + Angular stomatitis
NO NEUROPATHY
Two types of neural tube defects in babies
Failure to close anterior neuropore = ANANCEPHALY = Absence of major portion of the brain + skull
Failure to close posterior neuropore = SPINA BIFIDA = Incomplete closure of the vertebrae + membranes of the spinal cord
Diagnosis
FIRST LINE = FBC + Blood film = MACROCYTIC MEGALOBLASTIC
Low serum folate
Treatment
Dietary advice = leaf greens, brown rice
FOLIC ACID TABLETS NEVER WITHOUT B12 as giving folate first depletes B12 more due to complex DNA synthesis pathway (unless patient known to have normal B12)
Pregnant prophylaxis
Prophylactic folate 400mg for first 12 weeks (ensure baby develops okay)
Complications
CVD
- chest pain
- slurred speech
- paralysis
