Folic acid
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Folic acid, also known as vitamin B9, is a water-soluble B vitamin essential for: DNA synthesis and repair, Red blood cell formation
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🧪 What is Folic Acid?
Folic acid, also known as vitamin B9, is a water-soluble B vitamin essential for:
- DNA synthesis and repair
- Red blood cell formation
- Neural tube development in fetuses
- Amino acid metabolism
It exists naturally as folate in foods and is absorbed in the small intestine, mainly the jejunum.
❓ Why is the Folic Acid Test Done?
To:
- Diagnose folate deficiency, especially in patients with anemia or malnutrition
- Evaluate megaloblastic anemia (enlarged red cells due to impaired DNA synthesis)
- Monitor patients on folic acid supplements
- Assess nutritional status in pregnant women or those with malabsorption
- Differentiate B12 deficiency from folate deficiency (both can cause similar anemia)
📊 Normal Ranges
Parameter | Normal Range |
|---|---|
Serum Folic Acid | 2.7 – 17.0 ng/mL (may vary slightly by lab) |
Red Cell Folate | >140 ng/mL or >317 nmol/L (more accurate for long-term status) |
🔍 Red cell folate is a better indicator of long-term folate stores; serum folate can fluctuate based on recent intake.
📈 Interpretation of Results
Level | Interpretation |
|---|---|
<2.7 ng/mL (Low) | - Folate deficiency |
Normal (2.7–17.0 ng/mL) | Adequate folate levels |
>17 ng/mL (High) | Often due to excess supplementation; not usually harmful but can mask B12 deficiency |
🧠 Associated Organs and Conditions
System / Organ | Relevance |
|---|---|
Bone marrow | Needed for healthy red cell formation; deficiency causes megaloblastic anemia |
Gastrointestinal tract | Site of absorption; malabsorption leads to deficiency |
Liver | Stores and metabolizes folate |
Pregnancy | Deficiency linked to neural tube defects in fetus |
Neurological system | Deficiency (along with B12) can lead to neuropsychiatric symptoms |
❌ Symptoms of Folate Deficiency
- Fatigue, weakness
- Pale skin
- Glossitis (smooth tongue)
- Mouth sores
- Irritability, difficulty concentrating
- Macrocytic (large-cell) anemia
- In pregnancy: risk of neural tube defects (e.g., spina bifida)
🔄 Related / Follow-Up Tests
- Vitamin B12
- Complete Blood Count (CBC) – Macrocytic anemia
- Peripheral blood smear – Shows megaloblastic changes
- Homocysteine levels – Elevated in folate and B12 deficiency
- Methylmalonic acid (MMA) – Normal in folate deficiency, elevated in B12 deficiency
- Iron panel – To assess other causes of anemia
✅ Fasting Required?
Parameter | Fasting Required? |
|---|---|
Serum Folic Acid Test | ✅ Yes (8–10 hours fasting recommended) — to avoid post-meal fluctuations in serum folate levels |
🔍 Red cell folate does not require fasting.
📝 Summary
Parameter | Summary |
|---|---|
What | Folic acid (Vitamin B9) is vital for DNA synthesis, red cell production, and fetal development |
Why Test | To detect folate deficiency, evaluate macrocytic anemia, monitor nutritional therapy |
Normal Range | 2.7 – 17.0 ng/mL (serum) |
Low Levels | Suggest deficiency due to poor diet, malabsorption, alcohol, or drug effects |
High Levels | Often from supplementation; may mask B12 deficiency |
Follow-Up Tests | Vitamin B12, CBC, Homocysteine, MMA, blood smear |
Fasting Required | ✅ Yes, for serum folate (not red cell folate) |
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