Is a folate (folic acid) level of 2.2 ng/ml within the normal range?

Folate Level of 2.2 ng/ml Interpretation

A folate level of 2.2 ng/ml is below the normal range and indicates folate deficiency that requires treatment. 1

Normal Range and Interpretation

According to the FDA drug label information, normal serum folate levels range from 5 to 15 ng/mL, with levels below 5 ng/mL indicating folate deficiency, and levels below 2 ng/mL typically resulting in megaloblastic anemia 1. With a level of 2.2 ng/ml, this patient:

• Is below the normal threshold of 5 ng/mL
• Is just barely above the 2 ng/mL level associated with megaloblastic anemia
• Requires folate supplementation to prevent complications

Clinical Significance

Folate deficiency at this level has important clinical implications:

• May contribute to macrocytic anemia
• Can impair DNA synthesis and cell division
• May elevate homocysteine levels (significant rise occurs with serum folate under 8 μg/L or 18 nmol/L) 2
• Often coexists with other nutritional deficiencies 3

Associated Findings

A folate level of 2.2 ng/ml is frequently associated with:

• Other markers of malnutrition (present in 62.4% of patients with serum folate <7.0 ng/mL) 3
• Potentially lower hemoglobin, serum albumin, and vitamin B12 levels 3
• Higher prevalence of gastrointestinal disorders, sepsis, or abnormal kidney function 3

Recommended Next Steps

1. Check complete blood count to assess for macrocytic anemia
2. Measure vitamin B12 levels as deficiencies often coexist 4
3. Consider measuring homocysteine to improve interpretation of laboratory results 2
4. Evaluate for underlying causes of folate deficiency:
   • Gastrointestinal disorders
   • Malnutrition
   • Alcohol consumption (can cause acute drops in serum folate) 5
   • Medications that interfere with folate metabolism

Treatment Considerations

For a patient with this folate level, treatment should include:

• Oral folic acid supplementation at a dose of 1 mg daily for 3 months 4
• Repeat folate measurement within 3 months after supplementation to verify normalization 4
• Rule out concurrent vitamin B12 deficiency before initiating folate therapy to avoid masking neurological complications
• Address any underlying causes of folate deficiency

Common Pitfalls

• Overlooking B12 deficiency: Always check B12 status before treating folate deficiency to avoid masking neurological complications of B12 deficiency
• Failure to identify underlying causes: The folate deficiency may be a marker of other conditions requiring treatment
• Alcohol effect: Recent alcohol consumption can artificially lower serum folate levels without depleting actual folate stores 5
• Inadequate follow-up: Failure to recheck folate levels after treatment to confirm normalization

This folate level requires prompt attention and appropriate supplementation to prevent potential complications related to folate deficiency.