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CPE-009 · Classification
B12-13: Low folate
Low folate. Evaluates serum folate below 4.4 ng/mL (10 nmol/L) OR red-cell folate below 135 ng/mL (305 nmol/L).
Condition
- serum folate < 4.4 ng/mL (10 nmol/L) OR red-cell folate < 135 ng/mL (305 nmol/L)
Supportive, not required
- macrocytosis
- poor diet, alcohol use disorder, malabsorption
- folate-antagonist drugs (methotrexate, trimethoprim, phenytoin)
What it reports
- Biochemical pattern compatible with folate deficiency
Recommended next steps (for physician review)
- Check B12 together with folate, so a coexisting deficiency is not missed
Diagnostic boundary
- Serum folate reflects recent intake; red-cell folate reflects stores.
Evidence
- EV-BSH-2014Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.Supports: Diagnostic approach with serum B12, MMA and homocysteine Neurologic involvement means treatment should not wait for confirmation Folic acid alone must not be given while B12 deficiency is unexcluded
- EV-WHO-FOLATE-2015World Health Organization. Serum and red blood cell folate concentrations for assessing folate status in populations. Geneva: WHO; 2015.Supports: Serum folate below 10 nmol/L and red-cell folate below 305 nmol/L indicate deficiency
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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