Folate deficiency

Case history

A 70-year-old man presents for a routine physical exam. 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 exam reveals pallor, glossitis, flow murmur, and normal neurologic exam.

Other presentations

Subclinical folate deficiency can manifest as macrocytosis without severe anemia. Unexplained elevation of mean corpuscular volume should trigger testing for folate deficiency in addition to workup for other causes of macrocytosis.[2]Aslinia F, Mazza JJ, Yale SH. Megaloblastic anemia and other causes of macrocytosis. Clin Med Res. 2006 Sep;4(3):236-41. http://www.clinmedres.org/content/4/3/236 http://www.ncbi.nlm.nih.gov/pubmed/16988104?tool=bestpractice.com

Certain physiologic 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 hematologic findings, can lead to early recognition and treatment of folate deficiency.