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Page 79 of 93
Participation of folic acid in the course of a haemo cytopoiesis is closely bound with B12 vitamin. Deficit of folates leads to disturbance of processes of synthesis of DNA, RNA and development of megaloblastny anemia. Folates in enough come to an organism with foodstuff (meat, a liver, spinach, yeast etc.) and are soaked up in a small bowel. Reserves of folic acid in an organism it is less, than B12 vitamin therefore they are exhausted quicker.
At development of foliyevodefitsitny megaloblastny anemia the marrowy kinetics is characterized by disturbance of processes of proliferation of haemocytes, their death in S period — G2 of a cellular cycle, the high level of an inefficient haemo cytopoiesis.
Ways of emergence of deficit of folic acid are in many respects similar to those at deficit of B12 vitamin though there are certain features.
- Insufficiency of folates arises at absorption disturbance — diseases of a digestive tract, a Gee's disease, to a spr etc. One of causes of infringement of digestion of folates is long reception of anticonvulsant drugs — dipheninum, phenobarbital.
- The insufficient depot of folic acid is observed at newborns whose mothers had deficit of folates.
It should be noted that at pregnant women the need for folic acid increases many times over therefore at bad food, abuse of alcoholic drinks its deficit can develop. Especially easily deficit of folic acid arises at premature children.
- Exogenous deficit is observed at the babies raised by the goat milk poor in folates.
- Infectious and inflammatory diseases, diseases of biliary system quickly lead to exhaustion of reserves of folic acid.
In a clinical picture the asthenic syndrome is noted — children are uneasy, the sleep, appetite is interrupted. Patients complain of dizziness, the general weakness. Pallor of skin, an ikterichnost of scleras, a glossitis are objectively noted.
Table 39. Laboratory criteria of diagnosis of B12-scarce and foliyevodefitsitny anemia
Disease form |
Insufficiency of folic acid |
Insufficiency of vitamin B" |
Latent |
Concentration of folates in blood serum is reduced to 3 ng/ml
Concentration of folic acid in erythrocytes normal |
Concentration of B12 vitamin in blood serum is reduced to 100 ng/ml
Concentration of folic acid in an erythrocyte normal |
Manifest |
Concentration of folates in blood serum makes less than 3 ng/ml
Concentration of folic acid in erythrocytes is reduced and makes less than 100 ng/ml excretion with urine of formiminglutaminovy acid Is increased |
Concentration of Bi2 vitamin in blood serum makes less than 100 ng/ml Concentration of folic acid in erythrocytes decreases to 150 ng/ml
Excretion with urine of methyl-malonic acid is increased |
The hematologic picture is similar that at B12-scarce anemia: anemia of hyperchromic character, an anisocytosis with tendency to a macrocytosis, decrease in quantity of reticulocytes, a leukopenia, thrombocytopenia. In a miyelogramma — signs of irritation of a red sprout of a blood formation, change of a leucio-erythrocyte ratio, in a large number megaloblasts.
Differential diagnosis is carried out with B12-scarce anemia (tab. 39). Using special methods, reveal decrease in level of folic acid in blood serum and erythrocytes.
The special test — coloring of marrow alizeriny red at which the megaloblasts caused by deficit of B12 vitamin are painted over is offered and the megaloblasts caused by deficit of folic acid are not painted (L. Kass, 1976).
Treatment is directed to elimination of the reasons which caused deficit of folic acid. For this purpose it is enough to appoint folic acid inside, even at disturbance of intestinal absorption. The daily dose makes 10 — 30 mg. Treat within 20 — 30 days.
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