Red Cell Folate Testing

Conclusions

November 2010

True folate deficiency in the current era of FDA-mandated folic acid supplementation is exceedingly rare. There is no evidence to support routine ordering of RBC or serum folate, but serum folate concentrations provide equivalent clinical information to RBC folate in the assessment and diagnosis of folate deficiency. Based on these statistics, and because serum folate provides equivocal results to RBC folate in almost all clinical scenarios, routine ordering of RBC folate is no longer warranted. Furthermore, investigation of megaloblastic anemia should preferentially be initiated with vitamin B12 testing instead of folate due to the low incidence of modern folate deficiency. In the absence of B12 deficiency, it is more cost effective to simply supplement with folic acid rather than routinely test and monitor a patient's folate status, similar to other nutritional deficiencies such as vitamin D.

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Jump to section:

• Introduction
• Folate
• Folate
• Selected Food Sources of Folate and Folic Acid*
• Causes of Folate Deficiency
• Laboratory Diagnosis of Folate Deficiency
• Folate and Vitamin B12 Deficiency
• Quantitation of Folate: Methods
• Differences Between Folate Immunoassays
• Analytical Imprecision: RBC Folate (CAP Surveys)
• Equivalence of Serum and RBC Folate
• Modern Folate Deficiency is Rare
• Mayo RBC/Serum Folate Orders 1999-2009
• Conclusions
• Questions?