Diagnosis of folate deficiency Serum folate

This may be measured microbiologically with Lactobacillus casei, by radioassay or by an enzyme-linked immunosorbence assay (ELISA) technique. The serum folate level is low in all folate-deficient patients. In most laboratories, the normal range is quoted as from 2.0 |g/L (11 nmol/L) to about 15 |g/L. The serum folate is markedly affected by recent diet; inadequate intake for as little as 1 week may cause the level to become subnormal. Because of this, the serum folate assay is a very sensitive test and may show a low result before there is haematological or other biochemical evidence of deficiency.

The serum folate level rises in severe cobalamin deficiency because of blockage in conversion of methyl THF, the major circulating form, to THF; raised levels have also been reported in the intestinal stagnant loop syndrome, acute renal failure and active liver damage. (High levels are also obtained when the patient is receiving folic acid therapy, when the serum is contaminated with folate or folate-producing bacteria or, if a sample is haemolysed, because of the high concentration of folate in red cells.)

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