Folic acid deficiency

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Etiology

  • Nutritional (alcoholism)
  • Pregnancy
  • Phenytoin, primidone, phenobarbital
  • Trimethoprim (DHF reductase inh)
  • Methotrexate (DHF reductase inh)

Presentation

Megaloblastic anemia

Diagnosis

  • MCV > 100
  • Hypersegmented neutrophils
  • homocysteine

Differential diagnosis

B12 def. (MMA)

Treatment

  • Supplementation
  • Folinic acid (leucovorin) for MTX toxicity