These guidelines are being issued to provide nationally agreed advice for Scotland on appropriate requesting and interpretation of serum folate deficiency.
Serum folate testing is often performed indiscriminately as part of routine screening and can lead to unnecessary diagnostic and management quandries.
Red cell folate is no longer available routinely.
Folate deficiency: Folate is present in leafy vegetables and fruit but is destroyed by overcooking. It is not stored in the body and so mild dietary deficiency is very common. Folate and iron are absorbed in the jejunum so combined deficiency is very suggestive of Coeliac disease or inflammatory bowel disease. The most useful investigation is dietary history.
Causes of Low Serum Folate Levels:
- Insufficient/Poor diet
- Malabsorption syndromes
- Drug treatment (colestyramine, sulfasalazine, methotrexate)
- Increased cell turnover (haemolysis, haemoglobinopathy, exfoliative skin disease)