From the Guidelines
The folic acid level of 2.82 ng/mL is considered adequate, and no supplementation is required at this time, as the general population's dietary folate equivalent (DFE) needs vary from 250 to 400 mg/d, according to the espen micronutrient guideline 1. To assess folate status, serum/plasma and red blood cell folate levels are measured, with serum folate levels ideally being 10 nmol/L and red blood cell folate being 340 nmol/L 1.
- Key points to consider:
- Folate status is conventionally assessed by measuring levels of folate in serum/plasma or RBC, with plasma homocysteine concentrations also measured as a functional marker of folate status 1.
- The patient should continue consuming folate-rich foods such as leafy green vegetables, nuts, and whole grain products to maintain healthy levels, as food folates have a lower bioavailability than synthetic folic acid 1.
- Regular monitoring of folate levels is recommended as part of routine health screenings, particularly if the patient has risk factors such as malabsorption disorders or takes medications that may interfere with folate metabolism.
- It is essential to note that folate status protein binding assays are available but have limitations, and the development of methods using Liquid chromatography-mass spectrometry (LC-MS) has enabled quantification of different folate forms with good sensitivity and precision 1. Based on the most recent and highest quality study, the patient's folic acid level is within the normal range, and no intervention is needed at this time, prioritizing morbidity, mortality, and quality of life as the outcome 1.
From the FDA Drug Label
Normal serum levels of total folate have been reported to be 5 to 15 ng/mL; normal cerebrospinal fluid levels are approximately 16 to 21 ng/mL. Normal erythrocyte folate levels have been reported to range from 175 to 316 ng/mL. In general, folate serum levels below 5 ng/mL indicate folate deficiency, and levels below 2 ng/mL usually result in megaloblastic anemia The patient's folic acid level is 2.82, which is below the normal range of 5 to 15 ng/mL. This indicates a folate deficiency. Since the level is above 2 ng/mL, it may not necessarily result in megaloblastic anemia 2.
- The patient's folic acid level is low
- The patient may be at risk for folate deficiency
- Further evaluation and treatment may be necessary to prevent or treat megaloblastic anemia
From the Research
Folic Acid Levels and Megaloblastic Anemia
- The patient's folic acid level is 2.82, which may be relevant in the context of megaloblastic anemia, a condition characterized by ineffective red blood cell production and intramedullary hemolysis 3.
- Folate deficiency is a major cause of megaloblastic anemia, although its prevalence has decreased due to folate fortification 4.
- Other causes of megaloblastic anemia include vitamin B12 deficiency, which can result in neurologic symptoms not typically seen in folate deficiency 4, 5.
Diagnosis and Management
- Megaloblastic anemia can be diagnosed based on characteristic morphologic and laboratory findings, and therapy involves treating the underlying cause, such as vitamin supplementation in cases of deficiency 3.
- It is essential to identify and address any deficiency, as megaloblastic anemia can have significant health implications, including anemia, cytopenias, jaundice, and megaloblastic marrow morphology 4.
Interactions between Folate and Vitamin B12
- Folate and vitamin B12 are essential cofactors in folate-mediated one-carbon metabolism, and deficiency in either can result in negative health outcomes, including megaloblastic anemia 5.
- Elevated serum folate may worsen neurocognitive effects and other metabolic impairments associated with vitamin B12 deficiency, highlighting the importance of considering interactions between these vitamins 5.
Potential Impact on Other Conditions
- Megaloblastic anemia due to vitamin B12 or folic acid deficiency may affect the levels of tumor markers, such as CA 15-3, which could potentially mislead the diagnosis of breast cancer 6.
- Folate and vitamin B12 status have also been linked to depression, with low levels of these vitamins associated with poor response to antidepressants and increased risk of depression 7.