Anemia due to folic acid deficiency
Introduction
Introduction to anemia caused by folic acid deficiency Most plant and animal tissues contain folic acid (pteroylglutamic acid, folic acid) in the form of reduced methyl and formyl polyglutamate. Tetrahydrofolate is transported in one carbon unit (as in the biosynthesis of purine and pyrimidine nucleotides), amino acid conversion (such as histidine is converted to glutamic acid by iminomethylglutamic acid) and formate The production and utilization of coenzymes. Folic acid utilization disorders caused by various causes can lead to anemia, called anemia caused by folate deficiency. basic knowledge The proportion of illness: 0.026% Susceptible people: no special people Mode of infection: non-infectious Complications: blood deficiency, dizziness, dizziness
Cause
Causes of anemia caused by folic acid deficiency
Causes
Lack of body: Folic acid is abundant in foods such as green leafy vegetables, yeast, liver, edible fungi, but it can be destroyed by prolonged cooking. In the absence of folic acid intake, liver storage can only be provided. 2 to 4 months of need, the amount of folic acid intake through the diet is often insufficient, alcohol can interfere with the intermediate metabolism of folic acid, intestinal absorption and intrahepatic storage, so eat very few people (such as only tea and bread or Long-term alcohol abuse) is easy to cause large cell anemia due to folic acid deficiency. As seen in patients with chronic liver disease, pregnant women are prone to megaloblastic anemia because the fetus gets folic acid from the mother.
Malabsorption: Intestinal malabsorption is another common cause of folate deficiency. In tropical inflammatory diarrhea, malabsorption is secondary to atrophy of the intestinal mucosa caused by folate deficiency, even if a small dose of folic acid is given to eliminate anemia. In patients with long-term use of anticonvulsants or oral contraceptives, folate deficiency can occur due to reduced absorption.
Folic acid deficiency: long-term use of antimetabolites (methotrexate) and antimicrobial agents (such as trimethoprim / sulfamethoxazole), due to interference with folate metabolism, lack of folic acid, and finally, in pregnancy , lactation, chronic diseases, especially hereditary hemolytic anemia or psoriasis, as well as long-term dialysis, due to the need for increased, there will be folic acid deficiency.
Prevention
Prevention of anemia caused by folic acid deficiency
Use iron and vitamin B12 or folic acid in combination, and pay attention to improve feeding, increase the diet rich in iron, vitamin B12 and folic acid.
Complication
Anemia deficiency caused by folic acid deficiency Complications, blood deficiency, dizziness, dizziness
A common complication of this disease is a neural tube defect with severe neurological deficits in the fetus when the folic acid intake is insufficient during pregnancy.
Symptom
Symptoms of anemia caused by folic acid deficiency Common symptoms Malnutrition
The basic clinical manifestations are the symptoms and signs of anemia. It is difficult to distinguish folic acid or vitamin B12 from the results of peripheral blood and bone marrow examination, but no neuropathy in folate deficiency. In the fetal and infancy nervous system, folic acid is essential. Insufficient folic acid intake during pregnancy can occur with neural tube defects with severe neurological deficits, another uncommon neurological symptoms, restless legs are also associated with folate deficiency, this disease and other types of giants The main test for the identification of cell anemia is to indicate that folic acid is insufficient. If the serum folate level is <4ng/ml (<9nmol/L), it indicates folate deficiency. If the erythrocyte folate level is low (normally 225~600ng/ml), the lack of confirmed tissue can be confirmed. (The normal range of criteria depends on the test method used), but the above two tests can lead to false positives and false negatives. Serum high (homo) cysteine assays provide the most reliable basis for tissue deficiency, but vitamins. B12 also has the same route, so both Methyldithiouric acid and homocysteine should be tested. If the test results are normal, the previous item is elevated. Folic acid deficiency can be diagnosed.
Examine
Examination of anemia caused by folic acid deficiency
In addition to blood and bone marrow, serum lactate dehydrogenase (LDH) is significantly increased, serum folic acid content can be measured, normal 5 ~ 20g / ml, such as less than 3g / ml can be diagnosed, at this time, can be experimental Treatment, with a "physiological" dose of folic acid 50 ~ 200g once orally, if the megaloblastic anemia caused by folic acid deficiency, serum iron decreased 24 to 48 hours after administration, after 2 to 3 days, the number of reticulocytes increased, 5 ~ At the peak of 7 days, the number of platelets and white blood cells increased to normal with the increase in the number of reticulocytes. This amount is ineffective for megaloblastic anemia caused by vitamin B12 deficiency.
Diagnosis
Diagnosis and diagnosis of anemia caused by folic acid deficiency
Different from the megaloblastic anemia caused by vitamin B12 deficiency, it is difficult to distinguish folic acid or vitamin B deficiency according to the results of peripheral blood and bone marrow examination, but no neuropathy when folic acid is lacking.
