#Hematology_20 #Anemia #Macrocytic_anemia_5 في حالات ال fo | "لعلي أفيدك" Clinical discussion

#Hematology_20 #Anemia #Macrocytic_anemia_5

في حالات ال folate deficiency اول شي بيقل هو ال serum folate يتبعه ال RBCs folate وبعدها ببدأ يصير Macrocytosis و anemia
حسب ال BCSH قالك لو ال Serum folate كانت اقل من 3mcg/l
فهاد Indication لل Folate deficiency
اما البراكتس فبيستخدمو Cutoff value كالتالي :
Deficient: <2 ng/mL

Borderline: 2 to 4 ng/mL

Normal: >4 ng/mL

لو طلع المريضborderline زي ما شفنا مبارح بحالات ال B12
هنشوف قيمة ال MMA وال Homocysteine
لو كان ال MMA نورمال وال homocysteine عالي
معناها في Folate deficiency
لو ال MMA وال Homocysteine عاليين كلاهماا يبقى ال B12 هو اللي فيه نقص
because folate and vitamin B12 are metabolically interdependent, it is important to also evaluate for underlying or coexistent vitamin B12 deficiency (BCSH Grade 1A), which can lead to irreversible neurological damage if left untreated
مهم جدااا في حالات نقص ال folate وهنعطي المريض
Folic acid supplement
نقيسله ال B12 ولو كان ناقص نعوضه
ولو ما عوضناه واخد folate فقط هيدخل ب Neural Damage

for patients with macrocytic anemia, consider folate supplementation rather than serum folate testing ; response to therapeutic doses of folate is indicative of folate deficiency

additional testing used in specific situations

red blood cell (RBC) folate conflicting recommendations

British Committee for Standards in Haematology (BCSH) states routine testing is not recommended, since serum folate is often sufficient for diagnosis (BCSH Grade 1A)

• consider RBC folate if there is strong clinical suspicion of folate deficiency in patients with normal serum folate level and vitamin B12 deficiency ruled out (BCSH Grade 2B)

American Society for Clinical Pathology recommends against testing RBC folate

plasma homocysteine is elevated in both folate and vitamin B12 and should only be used to confirm suspected folate deficiency;
plasma levels > 15 mcmol/L may indicate folate deficiency but should be assessed relative to local ranges

if there is suspicion of coexistent vitamin B12 deficiency serum folate is preferred marker of folate deficiency over RBC

ال serum folate احيانا بيطلع False positive
"false-positive" results for folate deficiency based on serum folate can result when serum folate levels are reduced despite adequate supply to tissues, and may occur in cases of
low dietary folate intake
anorexia
acute alcohol consumption
pregnancy
use of anticonvulsant drugs

واحيانا ال Serum folate بيطلع false negative

"false-negative" results (falsely normal or high levels of serum folate) may occur

in patients with hemolysis or vitamin B12 deficiency

as a result of impaired methionine synthase and accumulation of methyltetrahydrofolate
OR
folate concentration in red blood cells are 30 time higher compared to plasma; even small amount of intravascular hemolysis can lead to elevated folate levels, potentially masking cellular folate deficiency

if testing for serum folate occurs immediately after ingesting a meal with dietary folate or an oral supplement of folic acid
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