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Symptoms and Signs – Differential Diagnosis of Folate Deficiency
• Acute cerebral folate deficiency
• Congenital folate malabsorption (rare)
• Decreased diet and increased requirements
• Decreased dietary intake
• Familial aplastic anemia (rare)
• Folate antagonists (e.g., methotrexate)
• Hereditary enzyme deficiencies involving folate
• Institutionalized individuals (e.g., psychiatric, nursing homes), chronic debilitating disease
• Intensive care unit setting
• Multiple effects on folate metabolism (e.g., alcohol, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, diphenylhydantoin, barbiturates)
• Pathologic (e.g., intrinsic hematologic diseases involving hemolysis with compensatory erythropoiesis, abnormal hematopoiesis, or bone marrow infiltration with malignant disease and dermatologic disease such as psoriasis)
• Physiologic (e.g., pregnancy and lactation, prematurity, hyperemesis gravidarum, infancy)
• Poverty and famine
• Prolonged feeding of infants with goat’s milk, special slimming diets or food fads (i.e., folate-rich foods not consumed), cultural or ethnic cooking techniques (i.e., food folate destroyed)
• Some drugs (controversial)
• Uncertain origin
• With mucosal abnormalities (e.g., tropical and nontropical sprue, regional enteritis)
• With normal intestinal mucosa
• Acute cerebral folate deficiency
• Congenital folate malabsorption (rare)
• Decreased diet and increased requirements
• Decreased dietary intake
• Familial aplastic anemia (rare)
• Folate antagonists (e.g., methotrexate)
• Hereditary enzyme deficiencies involving folate
• Institutionalized individuals (e.g., psychiatric, nursing homes), chronic debilitating disease
• Intensive care unit setting
• Multiple effects on folate metabolism (e.g., alcohol, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, diphenylhydantoin, barbiturates)
• Pathologic (e.g., intrinsic hematologic diseases involving hemolysis with compensatory erythropoiesis, abnormal hematopoiesis, or bone marrow infiltration with malignant disease and dermatologic disease such as psoriasis)
• Physiologic (e.g., pregnancy and lactation, prematurity, hyperemesis gravidarum, infancy)
• Poverty and famine
• Prolonged feeding of infants with goat’s milk, special slimming diets or food fads (i.e., folate-rich foods not consumed), cultural or ethnic cooking techniques (i.e., food folate destroyed)
• Some drugs (controversial)
• Uncertain origin
• With mucosal abnormalities (e.g., tropical and nontropical sprue, regional enteritis)
• With normal intestinal mucosa
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