S/O

Assessment

Plan

Problem: S/O evidence

Etiology

Recommended Therapy

Goals/Monitoring Parameters

Patient Education

Subjective:

-Weakness

-Lethargy

-Cheilosis (chapping and fissuring of lips)

-Glossitis (tongue inflammation) 

Objectives:

Folate ß

MCV (macrocytic) Ý

MCHC (homochromic or normochromic) ß Û

Reticulocytes ß

RDW (variation in size) Ý

Hgb ß

Hct ß

1). Inadequate intake

-Alcohol abuse (interferes w/ absorption and activation of folate)

-Poor diet   

2).Increased demand

-Pregnancy & lactation

-Chronic hemodialysis

3). Malabsorption at the jejunum

-Jejunal resection

-Drugs: Phenytoin, Primidone, Oral contraceptives, cholestyramine, sulfonamides    

4).Altered metabolism

-Drugs (Inhibits DNA synthesis)— 6-thioguanine, azathioprine, 6-mercaptourine, methotrexate, trimethoprim, pyrimethamine, pentamidine

-Inborn Errors 

*Folate important for Cell division and for normal erythropoiesis

Minimum Daily Requirements: 50mcg/d

Recommended Daily intake: 200mcg/d

 Small body stores – 5-10mg;  Megloblastic anemia may occur within 3-4months.  

Folate (Folic Acid):  1mg PO QDx 4wks

 Folate 0.1mg as a nutritional supplement may be recommended for pts at risk for reoccurrence.

Goals:

Correct underlying cause

Restore folate levels

Relieve Symptoms

Restore Hgb, Hct

Monitor:

RBC morphology—normal w/in 24-48hrs

Reticulocytes: peak at day 10

Hematologic normalized w/in 10days

Anemia—corrected in 1-2 months

Take Daily

Avoid Alcohol

Regular Healthy Diet

Keep away from children