Folate deficiency anaemia - Clinicals, Diagnosis, and Management

Hematology

Clinicals - History

Fact Explanation
Weakness and lethargy Due to low Hb levels lead to less oxygen supply to tissues cause weakness (1) Weakness and lethargy
Due to low Hb levels lead to less oxygen supply to tissues cause weakness (1)
Palpitation Increased tissue demand increased pumping action of the heart cause palpitation (1) Palpitation
Increased tissue demand increased pumping action of the heart cause palpitation (1)
Shortness of breath on exertion Increased oxygen demand leads to increase respiration and its effort (1) Shortness of breath on exertion
Increased oxygen demand leads to increase respiration and its effort (1)
Angina Hypoxia of the cardiac cells due to hyperactive of the heart causing chest pain (1) Angina
Hypoxia of the cardiac cells due to hyperactive of the heart causing chest pain (1)
History of alcoholism Alcohol reduce absorption of folic acid and increases excretes via urine (2) History of alcoholism
Alcohol reduce absorption of folic acid and increases excretes via urine (2)
Risk people Pregnant mothers, women of child bearing age, infants, old adults (1.3) Risk people
Pregnant mothers, women of child bearing age, infants, old adults (1.3)
Children- showing irritability, chronic diarrhea and failure to thrive Due to folate deficiency.(4) Children- showing irritability, chronic diarrhea and failure to thrive
Due to folate deficiency.(4)

Clinicals - Examination

Fact Explanation
Pallor Reduced Hb levels as a result of bone marrow hypo proliferation leading to reduced RBC production (1) Pallor
Reduced Hb levels as a result of bone marrow hypo proliferation leading to reduced RBC production (1)
Atrophic painful glossitis Reduced renewal of mucous membranes of the tongue (1) Atrophic painful glossitis
Reduced renewal of mucous membranes of the tongue (1)
Angular stomatitis Reduced renewal of mucous membranes of the corners of the mouth (1) Angular stomatitis
Reduced renewal of mucous membranes of the corners of the mouth (1)
Bleeding disorders like petechiae reduction of production of platelets in bone marrow (1) Bleeding disorders like petechiae
reduction of production of platelets in bone marrow (1)

Investigations - Diagnosis

Fact Explanation
Full Blood Count To detect the Haemoglobin Levels, macrocytes using red cell indices, the number of reticulocytes [ in severe defeciencies the number of all blood cells get reduced and this is called as
pancytopenia] (3.5)
Full Blood Count
To detect the Haemoglobin Levels, macrocytes using red cell indices, the number of reticulocytes [ in severe defeciencies the number of all blood cells get reduced and this is called as
pancytopenia] (3.5)
Blood picture To detect macrocytes, hyper segmented neutrophils in the blood (1.2) Blood picture
To detect macrocytes, hyper segmented neutrophils in the blood (1.2)
Serum folate levels To detect folate levels within reference range (normal 2.5-13.5 ng/ml). (3.5) Serum folate levels
To detect folate levels within reference range (normal 2.5-13.5 ng/ml). (3.5)
Bone marrow biopsy To detect megaloblasts (2) Bone marrow biopsy
To detect megaloblasts (2)
Serum homocysteine level To detect homocysteine level within reference range (4) Serum homocysteine level
To detect homocysteine level within reference range (4)

Investigations - Management

Fact Explanation
Prophylactic Folic Acid for all women planning a pregnancy. To reduction the risk of getting neural tube defect in babies. (1) Prophylactic Folic Acid for all women planning a pregnancy.
To reduction the risk of getting neural tube defect in babies. (1)

Management - Supportive

Fact Explanation
Dietary modifications requirement of folic acid. Add Folate rich vegetables/fruits in to the meals like Baby soyabeans, okra, spinach, asparagus, lettuce, avarcado, papaya, orange juice,mango to correct daily requirement of folic acid. (1) Dietary modifications requirement of folic acid.
Add Folate rich vegetables/fruits in to the meals like Baby soyabeans, okra, spinach, asparagus, lettuce, avarcado, papaya, orange juice,mango to correct daily requirement of folic acid. (1)

Management - Specific

Fact Explanation
Give oral folic acid for 4 months (0.4-1 mg/day) To correct serum folate levels (1) Give oral folic acid for 4 months (0.4-1 mg/day)
To correct serum folate levels (1)
Treat the underlying specific cause leading to folate deficiency anaemia. Coeliac disease which is a condition small intestine fails to digest and absorb food. (1) Treat the underlying specific cause leading to folate deficiency anaemia.
Coeliac disease which is a condition small intestine fails to digest and absorb food. (1)

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