Case history
Case history
A 70-year-old man presents for a routine physical examination. He complains of fatigue, shortness of breath, and painful swallowing. He admits to daily alcohol consumption and decreased consumption of fresh vegetables and fruits. Physical examination reveals pallor, glossitis, flow murmur, and normal neurological examination.
Other presentations
Sub-clinical folate deficiency can manifest as macrocytosis without severe anaemia. Unexplained elevation of mean corpuscular volume should trigger testing for folate deficiency, in addition to work-up for other causes of macrocytosis.[2]
Certain physiological or disease states that cause dietary insufficiency, malabsorption, and increased demand are associated with a high risk for folate deficiency. Awareness of the various causes, and vigilance for the haematological findings, can lead to early recognition and treatment of folate deficiency.
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