questions 3

Folic Acid

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Topic updated on 06/16/17 9:16am

Overview
  • Also known as vitamin B
    or folate
  • Used to form tetrahydrofolate (THF)
    • important for DNA and RNA synthesis
  • Found in leafy greens and fresh fruits
  • Absorbed in the jejunum and ileum
  • Small reserve pool is stored in the liver
    • lasts 3-4 months
Deficiency
  • Folic acid deficiency causes a megaloblastic anemia
  • Most common vitamin deficiency in the United States 
  • Causes
    • dietary deficiency
      • elderly
      • goat milk
    • alcoholism
    • pregnancy 
    • deficiency can be caused by several drugs
      • e.g., phenytoin, sulfonamides, methotrexate, EtOH, 5-fU, and oral contraceptives
  • Presentation
    • macrocytic, megaloblastic anemia 
    • homocystinemia
      • ↑ risk of DVT and atherosclerosis
      • supplemental folic acid can reverse this risk
    • no neurologic symptoms (as opposed to vitamin B12 deficiency)
    • deficiency in pregancy causes fetal neural tube defects
      • supplemental folic acid in early pregnancy reduces risk


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Qbank (1 Questions)

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(M2.NT.4750) A 58-year-old man with past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and tobacco use is brought to the emergency department by his sister for confusion. His sister reports that she and the patient were watching television together when the patient asked her to call their mother, who is deceased. His sister then noticed that he had difficulty walking to the bathroom. She reports that the patient has started drinking more since losing his job several months ago, but she insists that he has not had any alcohol while she was with him today. The patient’s home medications include hydrochlorothiazide, rosuvastatin, and albuterol as needed. His temperature is 97.9°F (36.6°C), blood pressure is 145/93 mmHg, pulse is 82/min, respirations are 12/min, and SpO2 is 96%. On physical exam, he is alert and oriented to person, place, and time. His eyes appear to flick to the right when he is asked to look to the left. The patient’s blood alcohol level is normal. Additional laboratory tests are performed and reveal the following:

Leukocyte count: 7,200/mm^3
Hemoglobin: 9.1 g/dL
Hematocrit: 29%
Mean corpuscular volume: 109 µm^3
Platelet count: 188,000/mm^3

A peripheral smear is performed and can be seen in Figure A.

What is the most likely cause of the findings seen on peripheral smear? Topic Review Topic
FIGURES: A          

1. Alcohol withdrawal
2. Thiamine deficiency
3. Iron deficiency
4. Folate deficiency
5. Vitamin B12 deficiency

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