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FOLIC ACID DEFICIENCY -This also means that the red blood cells appear bloated and large and
FOLIC ACID have a reduced capacity to carry oxygen
SOURCE
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HEMATOLOGY LECTURE MIDTERM - FOLIC ACID DEFICIENCY MLS 3G | J.Benedicto-M.Draper
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HEMATOLOGY LECTURE MIDTERM - FOLIC ACID DEFICIENCY MLS 3G | J.Benedicto-M.Draper
Symptoms related to the Alimentary Tract Empty space in replicated DNA sequence which results in single-strand
o Glossitis loss of epithelium on the tongue that results in a breaks
smooth surface and soreness Although the DNA can unwind and replication can begin, at
o Loss of epithelium along the gastrointestinal tract any point where a thymidine nucleotide is needed, there is
- Can result in gastritis, nausea or constipation an empty space in the replicated DNA sequence, which
Compared to vitamin b12 deficiency, folate deficiency was believed results in many single-strand breaks.
to be more benign or less harmful. Repeated DNA strand breaks lead to fragmentation
Cardiovascular disease Of the DNA strand
- Low levels of folate and the resulting high The resulting DNA is non-functional and the DNA
homocysteine levels were risk factors for replication is incomplete
Evidence of depression, peripheral neuropathy and psychosis Cell division is halted, resulting in cell lysis or apoptosis
Folate deficiency during pregnancy can result in impaired formation Cells that survive continue the abnormal maturation with a
of the fetal nervous system, resulting in fewer number of RBCs
o Neural Tube Defects such as spina bifida Remaining erythroid cells are larger
Than normally seen and their
Pregnancy requires an increase in folate to fulfill the requirements related to Nuclei are immature-appearing
rapid fetal growth, uterine expansion, placental maturation and expanded Compared with the cytoplasm
blood volume. The nuclei of megaloblastic erythroid precursors have an
open, finely stippled, reticular pattern
PATHOPHYSIOLOGY Cell cycle delay, prolonged resting phase and arrest in nuclear
maturation
Impaired thymidine nucleotide production The nuclear changes seen in the megaloblastic cells are
When either folate or vitamin b12 is missing, thymidine related to
nucleotide production for DNA synthesis is impaired.
Compared to vitamin B12, folate has the more direct effect LABORATORY TESTS
since it prevents the methylation of dUMP. While vitamin
b12 has an indirect effect preventing the production of THF SCREENING TESTS FOLATE DEFICIENCY
from 5-methyl THF. Complete blood count Decreased HGB, HCT, RBCs, WBCs, PLTs
Folate trap happens when vitamin b12 is deficient thus Increased MCV, MCH
more of the folate becomes metabolically trapped as 5- Manual differential count Hyper-segmented neutrophils, oval
methly THF and is unable to supply the folate cycle with macrocytes, anisocytosis, poikilocytosis, RBC
THF. inclusions
Incorporation of uridine into DNA Absolute reticulocyte count Decreased
So in this state of diminished thymidine availability, uridine Serum total and indirect Increased
is incorporated into DNA. bilirubin
The DNA repair process can remove the uridine, but Serum lactate dehydrogenase Increased
without available thymidine, the repair process is
unsuccessful.
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HEMATOLOGY LECTURE MIDTERM - FOLIC ACID DEFICIENCY MLS 3G | J.Benedicto-M.Draper
CASE STUDY
TREATMENT
Increasing dietary intake of folate
- By eating food like beans, oatmeal, mushrooms,
broccoli, asparagus, beef and liver
Folic acid supplement
Use of a food steamer or a microwave oven when cooking since
they can help keep more folate content in the cooked food, helping
to prevent folate deficiency
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