Folate deficiency

Folate present in leafy green vegetables and fruit; total body stores sufficient for 2–3mo

Etiologies: malnutrition (alcoholics, anorectics, elderly), ↓absorption(sprue),

impaired metabolism (methotrexate, pyrimethamine, trimethoprim), ↑ requirement (chronic hemolytic anemia, pregnancy, malignancy, dialysis)

Diagnosis: ↓ folate; ↓ RBC folate, ↑ chomocyst. but nl methylmalonic acid (unlike B12defic.)

Treatment: folate 1–5 mg PO qd for 1–4 mo or until complete hematologic recovery;

critical to r/o B12 deficiency first