Folic Acid

Liver, particularly beef liver, is one of the richest dietary sources of folic acid. Folic acid, also known as folate or vitamin B9, plays a crucial role in many bodily functions including DNA synthesis and repair, cell division, and growth. It's also essential for the production of red blood cells and preventing anemia.

Drugs interfering with folate metabolism

• triMETHoprim
• METHotrexate
• pyriMETHamine

Drugs which can reduce absorption

• phenytoin

Folate deficiency

Causes:

reduced dietary intake (elderly, preganacy, etc)

drug inhibition (phenytoin, alcohol, 5-fluorouracil, methotrexate, and trimethoprim)

and malabsorption (coeliac disease, Whipple's disease)

Findings:

Clinically, no neurological symptoms as in B12 deficiency

Lab:

Macrocytic anemia (MCV >100) - RBCs are described as "macro-ovalocytes"

hypersegmented neutrophils

Plasma homocysteine levels are elevated