Why this test?
To find out whether the lack of folic acid is the cause of megaloblastic anemia, glossitis, esophagitis, atrophic gastritis, enteritis.
For the differential diagnosis of megaloblastic anemia caused by hypovitaminosis of folic acid and B12.
To assess the level of folic acid when planning a pregnancy or with malabsorption syndrome.
To develop recommendations for nutritional correction.
In what cases is it prescribed?
- With megaloblastic anemia, glossitis, esophagitis, atrophic gastritis, enteritis.
- As part of a comprehensive assessment of the body's vitamin profile.
- When it is important to prevent folic acid deficiency (during breastfeeding, hemodialysis).
- When planning a pregnancy (for the prevention of congenital malformations, especially of the nervous system).
- With malabsorption syndrome (for the diagnosis of possible folic acid vitaminosis).
- When monitoring the effectiveness of hypovitaminosis treatment.
Folic acid (vitamin B9) is a water-soluble vitamin. It was first isolated from spinach leaves, but 20 years before that, the role of liver and yeast in the treatment of megaloblastic anemia, a condition that develops with folic acid deficiency, was established.
Folic acid enters the body with food. It is found in beans, parsley, lettuce, cabbage, tomatoes, spinach, asparagus, liver, kidneys, meat, mushrooms, yeast and is destroyed at high temperatures. Part of folic acid is produced by intestinal microflora in the presence of para-aminobenzoic acid. In addition, there are reserves of folacin in the liver and kidneys, which can compensate for its insufficient intake for several months.
Folic acid is absorbed in the small intestine: in its mucosa, biochemical transformations of the vitamin occur with the formation of active forms that can pass into the blood and participate in biochemical reactions. The role of B9 in the body is its ability to transfer methyl residues (CH3-) - these are reactions during which DNA and some amino acids (glycine, methionine) are formed.
With hypovitaminosis, DNA synthesis slows down and abnormal DNAs appear, which easily disintegrate due to the replacement of thymine nucleotides with uridine ones. With such a violation, cells and tissues that are often renewed - blood and epithelium - are the first to suffer, which determines the symptoms of folic acid hypovitaminosis.
Megaloblastic anemia develops, which is manifested by pallor, weakness, fatigue, atypical cells are visible in the blood test. In addition, the number of other blood elements - platelets and leukocytes - decreases, and their abnormal forms appear.
Another tissue that suffers from a lack of folic acid is the epithelium: wounds heal more slowly, the gastrointestinal tract suffers - the production of enzymes necessary for digestion decreases, glossitis (damage of the tongue), esophagitis (damage of the esophagus), gastritis, enteritis develops.
It is important to distinguish megaloblastic anemia caused by folate deficiency from that caused by vitamin B12 deficiency. At the second, large doses of folates are able to correct disorders in the patient's blood, but neurological complications progress.
In addition to the formation of DNA, folic acid is involved in the production of methionine from homocysteine. With hypovitaminosis, the amount of homocysteine increases, which increases the likelihood of cardiovascular diseases.
A sufficient level of folates in the body reduces the risk of developing cancer and plays a special role during pregnancy, especially in the early stages - intensive cell division occurs in the fetus, future organs and tissues are laid, and the correct laying of the neural tube is especially important. Violation of these processes leads to malformations: abnormalities of the nervous system (anencephaly, hydrocephalus, spinal hernias), impaired limb formation, and heart defects. In addition, B9 deficiency during pregnancy can cause improper formation of the placenta and even termination of pregnancy.
A person needs 25 mcg of folic acid per day, but absorption losses increase the amount that should come with food to 50 mcg. The need for folic acid increases during pregnancy and breastfeeding, as well as with malignant tumors, some types of hemolytic anemia, and skin diseases.
It is important to remember that the instability of the vitamin to cooking can lead to its lack in food. In addition, the development of hypovitaminosis is likely due to malabsorption - due to abuse of alcoholic beverages and acidic foods, taking some drugs (barbiturates, phenytoin), malabsorption syndrome.
At the same time, an excess of folic acid is extremely unlikely, because, being water-soluble, the vitamin is excreted in the urine.