Trip Answers

Question answered:19/09/07 Warning! this question is over two years old.

We found no specific recommendation blood levels should be rechecked in patients being treated for folate deficiency following four months of treatment.

 

The CKS guideline on macrocytic anaemia states:

 

“How do I treat folate deficiency?
• Treatment with oral folic acid, 5 mg daily, usually results in a rapid improvement in symptoms.
• Treatment is continued for 4 months to replenish stores, and should persist only if the underlying cause cannot be corrected.
• Vitamin B12 deficiency must be excluded in all people starting treatment for folate deficiency…
• Chronic haemolytic anaemias, such as sickle cell anaemia, thalassaemia major, and hereditory spherocytosis, result in increased folate demands because of the high turnover of red cells. Prophylactic folic acid is usually given.
• Coeliac disease should be considered in folate deficiency.” [1]

 

Smellie writing on monitoring patients with vitamin B12 or folate deficiency notes:

 

“Monitoring initial treatment
Vitamin B12 and folate deficiency: full blood count measurement at 10–14 days to document a rise in the haemoglobin and a fall in MCV and a further check after eight weeks to check that the blood count has returned to normal. No further monitoring is required once a full haematological response is achieved.

 

Monitoring longterm treatment
There is very little published guidance on the monitoring of vitamin B12 or folate deficiency.
Longterm folate replacement is considered unnecessary in most cases; the deficiency responds to short term treatment unless the cause (for example, malnutrition) persists.
…There is no obvious merit in repeating vitamin B12 and folate measurements during replacement unless lack of compliance (specifically folate) is suspected or anaemia recurs.” [2]

 

The Lab Tests Online website entry on vitamin B12 and folate gives similar information:

 

“When a patient is being treated for a vitamin B12 or folate deficiency, he may occasionally be monitored to evaluate the effectiveness of the treatment. In a person with a nutritional deficiency, this may be done as a follow-up to treatment. In a person with a condition causing a chronic deficiency, this may be part of a long term treatment plan.” [3]

 

References
1. CKS. Macrocytic anaemia. Last revised July 2005. (http://www.cks.library.nhs.uk/anaemia_macrocytic/)
2. Smellie WSA et al. Best practice in primary care pathology: review 1. J. Clin. Pathol. 2005;58;1016-1024 (http://jcp.bmjjournals.com/cgi/content/abstract/58/10/1016)
3. Lab Tests Online. Vitamin B12 and Folate. April 2005. (http://www.labtestsonline.org.uk/understanding/analytes/vitamin_b12/test.html).

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