Folate Deficiency Anemia Flashcards
What type of anemia is it?
Macrocytic megaloblastic
How long does it take to develop?
months to develop (vs B12 taking years)
Causes?
Malnutrition, Malabsorption, pregnancy, alcohol
trimethoprim
methotrexate
What is trimethoprim & methotrexate used for?
trimethoprim = Antibiotic used to kill bacteria by stopping folic acid formation which is needed for bacterias survival
Methotrexate = immunosuppressant for RA & crohns
How do both these drugs cause folate deficiency?
They’re both dihydrofolate reductase inhibitors
What is the mechanism that dihydrofolate reductase is used in?
mTHF—> THF
Where is folate found?
leafy green, legumes, lentils and animal proteins
How does a folate deficiency cause anemia?
Folic acid absorbed in the jejunum therefore decreased folic acid = haematopoetic stem cells make macrocytic RBCs & megaloblastic
Symptoms
general anemia + angular stomatitis & glossitis (like all haematinics)
(no neurological symptoms or lemon yellow skin, this is B12)
Diagnosis?
Tests done and results?
FBC + Blood film = microcytic megaloblasts (+ hypersegmented neutrophils)
Decreased serum folate
What may a patient have related to B12?
Concomitant B12 deficiency
Treatment
Dietary advice (leafy greens, brown rice)
Folate supplements
(if concomitant B12 def/folate def = REPLACE B12 FIRST; giving folate first depletes B12 more-complex DNA synthesis pathway)
What do you give to someone who’s pregnant?
prophylactic folate 40mg for first 12 weeks (ensures baby develops ok)
complication of this anemia
CVD
What other 3 diseases cause macrocytic non megaloblastic anemia? (non DNA synthesis affecting)
Alcohol
hypothyroidism
liver disease
