PDF 7,4 Mb - NVKC
PDF 7,4 Mb - NVKC
PDF 7,4 Mb - NVKC
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Folate Deficiency<br />
• Serum folate levels are of poor value<br />
or maybe even close to worthless<br />
– Genetic variation<br />
– Little correlation with tissue stores<br />
• Homocysteine tracks closer to tissue<br />
levels<br />
log(1st Hcy)<br />
Folate vs Hcy<br />
1.6<br />
1.5<br />
1.4<br />
1.3<br />
1.2<br />
1.1<br />
1<br />
.9<br />
.8<br />
.7<br />
.4 .6 .8 1 1.2 1.4 1.6 1.8 2 2.2<br />
log(Folate)<br />
Y = 1.312 - .212 * X; R 2 = .132<br />
MMA and Hcy as Diagnostic Tests<br />
MMA Hcy<br />
B 12 def INC INC<br />
Folate NL INC<br />
B 12 vs Folate<br />
B 12<br />
Folate<br />
Cause Malabsob Diet<br />
Time Slow Fast<br />
Neuro Yes No<br />
Blood Yes Yes<br />
Labs MMA/Hcy Hcy<br />
Response to Therapy<br />
• Anemia respond in one week<br />
• Parasthesias respond in 2 weeks<br />
• Most patients show responses but<br />
few recover full function<br />
Lack of response to<br />
B 12 /folate<br />
• Variation in response 3-7 days<br />
• Lack of erythropoietin<br />
• Lack of iron<br />
• Intrinsic marrow problem<br />
• Alcoholism<br />
30
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