Specific Test for Folate Deficiency Anemia

7/18/2019 Specific Test for Folate Deficiency Anemia

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SPECIFIC TEST FOR FOLATE DEFICIENCY ANEMIA

There are some specific test to confirm whether someone is having folate

deficiency anemia or not, such as folate serum test, red blood cell folate test,homocysteine serum test, formiminoglutamic acid (FIGLU) ecretion test, and

deoyuridine supression test!"#$

a$ Folate %erum Test and &ed 'lood ell Folate Test

Folate serum and red blood cell folate test are both needed to

confirm whether someone is really having a folatedeficiency anemia$

'oth tests are giving us information about the folate level status in the

patient*s body$ The folate in the serum will be found in the form of +methyltetrahydrofolate monoglutamate (+ethyl T-F monoglutamate)

and the folate in the red blood cell will be found in the form of various

polyglutamates.,#$

The red blood cell folate level will reflecting the folate level in the

last # months because the red blood cell (erythrocyte) life span is about

!./ days$ The folate serum will reflecting the current folate level in the

patient*s body and recently folate upta0e history$ That is why the red blood

cell folate level test is more reliable for detecting longterm folate

deficiency anemia and the folate serum test is more reliable in the

detecting acute folatedeficiency anemia#$ Ta0ing both test will help the

practician to 0now whether their patients is in state of acute or longterm

folatedeficiency anemia$

In the patient with folatedeficiency anemia, the folate level is low

both in the serum and in the red blood cell$ -owever, some cobalamin

deficiency anemia will also show a low red blood cell folate level

.

$Therefore, the patient will be confirmed with folatedeficiency anemia if

the cobalamin (vitamin '!.) level in the serum is normal (.//#//

pg1mL) and the folate serum level is low (2 # ng1mL) as shown in the

Table 1 below$



Table 1. Folate Serum Level Result Interpretaton to Dstn!us" t"e

Cobalamn#De$%en%& Anema an' t"e Folate#De$%en%& Anema!$

b$ -omocysteine and ethylmalonil 3cid %erum Test

The homocysteine serum test is needed to 0now if there is ecessive

accumulation of homocysteine in the patient*s body$ -omocysteine will be

acumulated if there is not enough folate in the patient*s body$ It is

happened because the methylation of homocysteine to methionine is +

ethyl T-F dependent reaction$ +ethyl T-F is come from the

metabolism of the folate in human body$ Therefore, if there is folate

deficiency, there is also accumulation of homocysteine$

-owever, the homocysteine serum level will also increased in the

cobalamindeficiency anemia or in the renal failure condition$ Therefore,

the patient*s also need to ta0e the methylmalonilacid (3) serum test

to distinguish between the cobalamindeficiency anemia and the folate

deficiency anemia$ The 3 reaction to become %uccinyl o3 is only

cobalamindependent, so it will only decreased in the cobalamin

deficiency anemia#$ The patient*s will be confirmed with folatedeficiency

anemia if the 3 serum level is normal and the homocysteine serum

level is low as shown in the Table ( below$



Table (. T"e )omo%&stene Serum Level an' T"e MMA Serum

Level to Dstn!us" t"e Cobalamn#De$%en%& Anema an' t"e

Folate#De$%en%& Anema!$

c$ Formiminoglutamic acid (FIGLU) 4cretion Test

The Formiminoglutamic acid (FIGLU) 4cretion Test is needed to

0now the FIGLU level in the urine$ FIGLU will be ecreted through urine

if there is ecessive amount1 accumulation of FIGLU in the patient*s

body.$

The FIGLU will be accumulated if there is folatedeficiency$ It is

happened because the formation of glutamic acid from FIGLU is

dependent on tetrahydrofolate which is come from folate metabolism as

shown on the p%ture 1 below.$ The patient*s will be diagnosed as the

folatedeficiency anemia if the FIGLU ecretion in the urine increased$

The normal value of FIGLU ecretion through urine is about . mg1 hour$



P%ture 1. *lutam% Formaton $rom Formmno!lutam% A%'

+FI*L,- Depent on Tetra"&'ro$ol% A%'$

d$ 5eoyuridine %upression Test

The deoyuridine suppression test is used to measure the efficiency

of which cells do the methylate the deoyuridine become the thymidilate

in the process of ma0ing 563$ The +,!/ethylenetetrahydrofolate is

needed in the thymidilate (dT7) formation from the deoyuridilate

(dU7)$ This reaction is folatedependent$ %o, if there is folatedeficiency

there is also supression in the dT7 ma0ing from dU7.$ The normal

range of the deoyuridine supression test is about below +8$ This test is

invassive because it has to be done in the bone marrow and not many labs

in the world perform this 0ind of test$

P%ture (. T"&m'late +'TMP- man! $rom Deo/&ur'late +',MP-

0"%" s Folate#Depen'ent Rea%ton$

REFERENCES



!$ 3ntony 3$ egaloblastic 3nemias$ Goldman*s ecil edicine9 Twenty

Fourth 4dition$ Twenty Fou$ 4lsevier Inc$: ./!!$ p$ !/;+"<#$

.$ Lan=0ows0y 7$ egaloblastic 3nemia$ an 7ediatr -ematol >ncol$

./!!:+<"<?$

#$ -offbrand 3@, oss 73-$ 4ssential -aemotology$ ?th ed$ ./!!$

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Specific Test for Folate Deficiency Anemia