TAILIEUCHUNG - Chapter 100. Megaloblastic Anemias (Part 15)

Folinic Acid (5-Formyl-Thf) This is a stable form of fully reduced folate. It is given orally or parenterally to overcome the toxic effects of methotrexate or other DHF reductase inhibitors. Prophylactic Folic Acid In many countries, food is fortified with folic acid (in grain or flour) to prevent neural tube defects. It is also used in chronic dialysis patients and in parenteral feeds. Prophylactic folic acid has been used to reduce homocysteine levels to prevent cardiovascular disease, but further data are needed to assess the benefit for this and for cognitive function in the elderly. Pregnancy Folic acid, 400 µg daily, should be given. | Chapter 100. Megaloblastic Anemias Part 15 Folinic Acid 5-Formyl-Thf This is a stable form of fully reduced folate. It is given orally or parenterally to overcome the toxic effects of methotrexate or other DHF reductase inhibitors. Prophylactic Folic Acid In many countries food is fortified with folic acid in grain or flour to prevent neural tube defects. It is also used in chronic dialysis patients and in parenteral feeds. Prophylactic folic acid has been used to reduce homocysteine levels to prevent cardiovascular disease but further data are needed to assess the benefit for this and for cognitive function in the elderly. Pregnancy Folic acid 400 pg daily should be given as a supplement before and throughout pregnancy. In women who have had a previous fetus with a neural tube defect 5 mg daily is recommended when pregnancy is contemplated and throughout the subsequent pregnancy. Infancy and Childhood The incidence of folate deficiency is so high in the smallest premature babies during the first 6 weeks of life that folic acid . 1 mg daily should be given routinely to those weighing 1500 g at birth and to larger premature babies who require exchange transfusions or develop feeding difficulties infections or vomiting and diarrhea. The World Health Organization currently recommends routine supplementation with iron and folic acid in children in countries where iron deficiency is common and child mortality largely due to infectious diseases is high. However some studies suggest that where malaria rates are high this approach may increase the incidence of severe illness and death. Even where malaria is rare there appears to be no survival benefit. Megaloblastic Anemia Not Due to Cobalamin or Folate Deficiency or Altered Metabolism This may occur with many antimetabolic drugs . . hydroxyurea cytosine arabinoside 6-mercaptopurine that inhibit DNA replication. Antiviral nucleoside analogues used in treatment of HIV infection may also cause macrocytosis and .

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