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J R Soc Med. 1998 February; 91(2): 72–73.
PMCID: PMC1296488

An audit of the investigation and treatment of folic acid deficiency.


On the suspicion that folate deficiency was not being thoroughly investigated we conducted a retrospective study of management in a teaching hospital. Notes from 84 consecutive patients with low red cell folates (mean age 69.5 years, range 21-95, M:F 33:51) were reviewed for haemoglobin, mean cell volume, dietary history, alcohol consumption, drug history, relevant medical history, relevant investigations, treatment, repeat measurement of red cell folate and diagnosis of deficiency. In 52 (61.9%, mean age 72.9 years, range 33-95, M:F 21:51) no diagnosis was reached. In only 32 (38.1%, mean age 63.9 years, range 21-89, M:F 12:20) was a definitive diagnosis established: 5 had coeliac disease, 1 had Crohn's disease, 9 had drug-associated deficiency (4 methotrexate, 3 phenytoin, 1 trimethoprim and 1 valproate), 1 had combined variable immunodeficiency and 16 had dietary deficiency. In most cases of folic acid deficiency no attempt was made to establish aetiology. We recommend that younger patients without an obvious cause are investigated initially by dietary assessment and measurement of anti-endomysial antibody and by duodenal biopsy with small-bowel follow-through if clinically indicated.

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Selected References

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  • Schwab RA, Powers RD. Prevalence of folate deficiency in emergency department patients with alcohol-related illness or injury. Am J Emerg Med. 1992 May;10(3):203–207. [PubMed]
  • Basu TK, Donald EA, Hargreaves JA, Thompson GW, Overton TR, Chao E, Peterson D. Vitamin B12 and folate status of a selected group of free-living older persons. J Nutr Elder. 1992;11(4):5–19. [PubMed]
  • Hercberg S, Galan P. Nutritional anaemias. Baillieres Clin Haematol. 1992 Jan;5(1):143–168. [PubMed]
  • Graham I, Meleady R. Heart attacks and homocysteine. BMJ. 1996 Dec 7;313(7070):1419–1420. [PMC free article] [PubMed]
  • Paspatis GA, Kalafatis E, Oros L, Xourgias V, Koutsioumpa P, Karamanolis DG. Folate status and adenomatous colonic polyps. A colonoscopically controlled study. Dis Colon Rectum. 1995 Jan;38(1):64–68. [PubMed]
  • Hoffbrand V, Provan D. ABC of clinical haematology. Macrocytic anaemias. BMJ. 1997 Feb 8;314(7078):430–433. [PMC free article] [PubMed]
  • Ortega RM, Redondo R, Andres P, Eguileor I. Nutritional assessment of folate and cyanocobalamin status in a Spanish elderly group. Int J Vitam Nutr Res. 1993;63(1):17–21. [PubMed]

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