The diagnosis of folate deficiency anaemia is made by:
clinical picture
often the cause is dietary - may be associated with other factors such as chronic disease, alcoholism, pregnancy
other causes include malabsorption, drugs, excessive utilisation of folate in malignancy, chronic well-compensated haemolysis (this may even occur with a normal haemoglobin level)
take a detailed history - consider causes noted above - diet, drugs, alcohol, symptoms of malabsorption
diagnosis of megaloblastic anaemia:
FBC - macrocytic anaemia
a thrombocytopaenia may occur secondary to ineffective megakaryopoiesis
blood film - macrocytosis, hypersegmented neutrophils
bone marrow - megaloblastic erythropoiesis, giant metamyelocytes
measurement of red cell folate levels; a good index of long term status as opposed to plasma folate levels which indicate recent nutritional status
also measure serum B12 levels and absorption - the other main cause of megaloblastic macrocytic anaemia
anti-gliadin and anti-endomysial antibodies - this may reveal subclinical coeliac disease
liver function tests other haematinics - if not already undertaken - a useful assessment of nutritional status
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