RBC Folate

Anemia

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Fasting Required

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RBC folate level.

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RBC Folate Test Information Guide

Why is it done?
- Measures folate levels stored within red blood cells to assess long-term folate status and nutritional adequacy over the preceding 2-3 months
- Diagnoses folate deficiency anemia and megaloblastic anemia caused by insufficient folate intake or absorption
- Evaluates patients with symptoms of anemia including fatigue, weakness, shortness of breath, and pallor
- Investigates macrocytic anemia (enlarged red blood cells) to differentiate folate deficiency from vitamin B12 deficiency
- Screens high-risk populations including pregnant women, patients with malabsorption disorders, and chronic alcohol users
- Monitors folate supplementation effectiveness in patients receiving treatment for documented deficiency
- Assesses nutritional status in patients with gastrointestinal diseases affecting nutrient absorption (celiac disease, Crohn's disease, cystic fibrosis)
Normal Range
- Reference Range: 140-960 ng/mL (or 317-2182 nmol/L)
- Normal Result: RBC folate within normal range indicates adequate folate stores and appropriate cellular function over the past 2-3 months
- Low Result: Below 140 ng/mL indicates folate deficiency with depleted red blood cell folate stores, suggesting chronic inadequate folate intake or absorption problems
- High Result: Above 960 ng/mL is rare but may indicate excess folate supplementation or certain medical conditions affecting folate metabolism
- Borderline Low: 140-200 ng/mL represents low-normal range suggesting early depletion of folate stores; clinical correlation and repeat testing may be warranted
- Units of Measurement: Nanograms per milliliter (ng/mL) or nanomoles per liter (nmol/L)
Interpretation
- Low RBC Folate (<140 ng/mL): Indicates folate-deficient erythropoiesis and cellular dysfunction; represents depletion of tissue folate stores accumulated over 2-3 months; more reliable indicator of chronic folate status than serum folate; associated with megaloblastic anemia, elevated homocysteine levels, and increased risk of neural tube defects in pregnancy
- Normal RBC Folate (140-960 ng/mL): Suggests adequate folate stores for normal DNA synthesis and cell division; indicates sufficient dietary intake or supplementation; rules out chronic folate deficiency but does not exclude acute serum folate depletion
- Factors Affecting Results:
  - Dietary intake of folate-rich foods (leafy greens, legumes, fortified grains)
  - Malabsorption conditions (celiac disease, inflammatory bowel disease, tropical sprue)
  - Medications including methotrexate, phenytoin, sulfasalazine, and trimethoprim that inhibit folate absorption or metabolism
  - Alcohol consumption which impairs folate absorption and increases urinary folate excretion
  - Pregnancy and lactation with increased folate demand and utilization
  - Hemolysis and rapid red blood cell turnover conditions
  - MTHFR gene mutations affecting folate metabolism efficiency
- Clinical Significance: RBC folate is more specific than serum folate for assessing long-term folate status; correlates better with tissue folate stores; superior indicator for identifying patients at risk for complications; more reliable for monitoring treatment response than single serum folate measurements
Associated Organs
- Primary Organ Systems:
  - Bone marrow and hematopoietic system - site of red blood cell production and folate utilization for DNA synthesis
  - Gastrointestinal tract - absorption site for dietary folate in the distal ileum and colon
  - Liver - storage of folate reserves and regulation of folate metabolism
- Conditions Associated with Low RBC Folate:
  - Megaloblastic anemia with abnormally large and immature red blood cells causing ineffective erythropoiesis
  - Celiac disease with villous atrophy reducing folate absorption capacity
  - Crohn's disease and ulcerative colitis impairing intestinal folate absorption
  - Tropical sprue with folate malabsorption and deficiency
  - Cystic fibrosis with pancreatic insufficiency affecting nutrient absorption
  - Chronic liver disease impairing folate metabolism and hepatic storage capacity
  - Alcoholism with combined effects of poor nutrition and impaired absorption and metabolism
  - Hemolytic anemias with increased red blood cell turnover and folate demand
- Complications of Folate Deficiency:
  - Neural tube defects (spina bifida, anencephaly) in pregnant women with inadequate folate status
  - Elevated homocysteine levels increasing cardiovascular disease risk
  - Cognitive dysfunction and neuropsychiatric manifestations including depression and dementia
  - Increased cancer risk from impaired DNA synthesis and repair mechanisms
  - Glossitis and mouth ulcers from epithelial cell impairment
  - Immune system suppression increasing infection susceptibility
Follow-up Tests
- Recommended if Low RBC Folate:
  - Serum folate - measures acute folate status and current dietary intake for comparison with RBC folate
  - Vitamin B12 level - to exclude combined B12 and folate deficiency causing megaloblastic anemia
  - Homocysteine level - elevated levels confirm functional folate deficiency and assess cardiovascular risk
  - Methylmalonic acid - helps differentiate B12 deficiency from folate deficiency
  - Complete blood count - assesses hemoglobin, hematocrit, MCV, and red blood cell morphology
  - Peripheral blood smear - evaluates for megaloblastic changes and hypersegmented neutrophils
  - Intrinsic factor antibodies and parietal cell antibodies - screen for pernicious anemia if B12 is also low
  - Tissue transglutaminase (tTG) antibodies - screen for celiac disease if malabsorption suspected
  - MTHFR gene testing - assess for genetic mutations affecting folate metabolism in select cases
- Monitoring During Treatment:
  - Repeat RBC folate level - 6-8 weeks after initiating supplementation to confirm adequate repletion
  - Complete blood count every 4-6 weeks until hemoglobin and hematocrit normalize
  - Homocysteine recheck 8-12 weeks after treatment initiation if initially elevated
- Long-term Monitoring:
  - Annual RBC folate levels in patients with chronic malabsorption conditions requiring long-term supplementation
  - Annual comprehensive metabolic panel in patients on methotrexate or other folate-antagonizing medications
  - Pre-conception folate assessment 3 months before pregnancy planning if prior deficiency documented
Fasting Required?
- Fasting Requirement: No - fasting is NOT required for RBC folate testing; test can be performed at any time of day
- Patient Preparation: Minimal preparation required; patient may eat and drink normally before blood draw
- Medications: Continue all regular medications unless specifically instructed otherwise by healthcare provider; folate supplementation should be noted for result interpretation; document all current medications including vitamins and supplements
- Specimen Collection: Venipuncture blood draw into standard collection tube (typically EDTA or heparin tube); minimal discomfort; no special post-collection care needed
- Timing Considerations: Test reflects folate status over previous 2-3 months; timing of meals or recent folate intake does not significantly affect results; consistent with serum testing protocols for vitamin status assessment

How our test process works!