TAILIEUCHUNG - Chapter 100. Megaloblastic Anemias (Part 14)

Serum Folate This is also measured by an ELISA technique. In most laboratories, the normal range is from 11 nmol/L ( µg/L) to ~82 nmol/L (15 µg/L). The serum folate level is low in all folate-deficient patients. It also reflects recent diet. Because of this, serum folate may be low before there is hematologic or biochemical evidence of deficiency. Serum folate rises in severe cobalamin deficiency because of the block in conversion of MTHF to THF inside cells; raised levels have also been reported in the intestinal stagnant loop syndrome, due to absorption of bacterially synthesized folate. Red Cell Folate The. | Chapter 100. Megaloblastic Anemias Part 14 Serum Folate This is also measured by an ELISA technique. In most laboratories the normal range is from 11 nmol L gg L to 82 nmol L 15 gg L . The serum folate level is low in all folate-deficient patients. It also reflects recent diet. Because of this serum folate may be low before there is hematologic or biochemical evidence of deficiency. Serum folate rises in severe cobalamin deficiency because of the block in conversion of MTHF to THF inside cells raised levels have also been reported in the intestinal stagnant loop syndrome due to absorption of bacterially synthesized folate. Red Cell Folate The red cell folate assay is a valuable test of body folate stores. It is less affected than the serum assay by recent diet and traces of hemolysis. In normal adults concentrations range 880-3520 iimol L 160-640 gg L of packed red cells. Subnormal levels occur in patients with megaloblastic anemia due to folate deficiency but also in nearly two-thirds of patients with severe cobalamin deficiency. False-normal results may occur if the folate-deficient patient has received a recent blood transfusion or if the patient has a raised reticulocyte count. Megaloblastic Anemia Treatment It is usually possible to establish which of the two deficiencies folate or cobalamin is the cause of the anemia and to treat only with the appropriate vitamin. In patients who enter hospital severely ill however it may be necessary to treat with both vitamins in large doses once blood samples have been taken for cobalamin and folate assays and a bone marrow biopsy has been performed if deemed necessary . Transfusion is usually unnecessary and inadvisable. If it is essential packed red cells should be given slowly one or two units only with the usual treatment for heart failure if present. Potassium supplements have been recommended to obviate the danger of the hypokalemia that has been recorded in some patients during the initial hematologic response.

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