Clinical utility of serum folate measurement in tertiary care patients: Argument for revising reference range for serum folate from 3.0ng/mL to 13.0ng/mL

Gurmukh Singh, Hana Hamdan, Vivek Singh

Research output: Contribution to journalArticle

Abstract

Objective: Assess the need for folate testing, frequency of corrective action, and determine reference level for serum folate. Methods: Serum folate levels in 5313 samples from 4448 patients, and clinical data were reviewed for patient characteristics and for (a) evidence of corrective action in patients with serum folate values <5.5 ng/mL, and (b) differences in patients with serum folate levels <5.5 ng/mL and patients with levels >25.7 ng/mL. Results: The prevalence of serum folate levels, in patients, <3.0, <4.0, <5.5, <7.0 and <13.0 ng/mL was 0.58%, 1.55%, 4.9%, 9.98% and 43.21% respectively. Patients with serum folate levels <5.5 ng/mL had lower serum albumin and hemoglobin. In 64% of patients with serum folate >25.7 ng/mL the sample was collected after supplementation with folic acid. Of the 128 patients with serum folate <5.5 ng/mL documentation of supplementation was present in only 38.9%. Conclusions: Serum folate levels are below the current "normal" level of 3.0 ng/mL in a larger proportion of tertiary care patients than that reported for ambulatory patients. In patients with folate deficiency, corrective action is lacking in >60% of the patients. Since serum folate levels ≥13.0 ng/mL are needed for optimal prevention of neural tube defects in the embryo/fetus, we propose that normal serum folate level should be designated to be ≥ 13.0 ng/mL.

Original languageEnglish (US)
Pages (from-to)35-41
Number of pages7
JournalPractical Laboratory Medicine
Volume1
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Tertiary Healthcare
Folic Acid
Reference Values
Serum
Neural Tube Defects
Fetus
Embryonic Structures
Defects
Testing

Keywords

  • Neural tube defects
  • Optimum serum folate level
  • Prevalence of folate deficiency
  • Serum folate
  • Utility of folate testing

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Clinical Biochemistry

Cite this

@article{06db581c17774f0984fc2d433bf62e10,
title = "Clinical utility of serum folate measurement in tertiary care patients: Argument for revising reference range for serum folate from 3.0ng/mL to 13.0ng/mL",
abstract = "Objective: Assess the need for folate testing, frequency of corrective action, and determine reference level for serum folate. Methods: Serum folate levels in 5313 samples from 4448 patients, and clinical data were reviewed for patient characteristics and for (a) evidence of corrective action in patients with serum folate values <5.5 ng/mL, and (b) differences in patients with serum folate levels <5.5 ng/mL and patients with levels >25.7 ng/mL. Results: The prevalence of serum folate levels, in patients, <3.0, <4.0, <5.5, <7.0 and <13.0 ng/mL was 0.58{\%}, 1.55{\%}, 4.9{\%}, 9.98{\%} and 43.21{\%} respectively. Patients with serum folate levels <5.5 ng/mL had lower serum albumin and hemoglobin. In 64{\%} of patients with serum folate >25.7 ng/mL the sample was collected after supplementation with folic acid. Of the 128 patients with serum folate <5.5 ng/mL documentation of supplementation was present in only 38.9{\%}. Conclusions: Serum folate levels are below the current {"}normal{"} level of 3.0 ng/mL in a larger proportion of tertiary care patients than that reported for ambulatory patients. In patients with folate deficiency, corrective action is lacking in >60{\%} of the patients. Since serum folate levels ≥13.0 ng/mL are needed for optimal prevention of neural tube defects in the embryo/fetus, we propose that normal serum folate level should be designated to be ≥ 13.0 ng/mL.",
keywords = "Neural tube defects, Optimum serum folate level, Prevalence of folate deficiency, Serum folate, Utility of folate testing",
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T2 - Argument for revising reference range for serum folate from 3.0ng/mL to 13.0ng/mL

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AU - Singh, Vivek

PY - 2015/1/1

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N2 - Objective: Assess the need for folate testing, frequency of corrective action, and determine reference level for serum folate. Methods: Serum folate levels in 5313 samples from 4448 patients, and clinical data were reviewed for patient characteristics and for (a) evidence of corrective action in patients with serum folate values <5.5 ng/mL, and (b) differences in patients with serum folate levels <5.5 ng/mL and patients with levels >25.7 ng/mL. Results: The prevalence of serum folate levels, in patients, <3.0, <4.0, <5.5, <7.0 and <13.0 ng/mL was 0.58%, 1.55%, 4.9%, 9.98% and 43.21% respectively. Patients with serum folate levels <5.5 ng/mL had lower serum albumin and hemoglobin. In 64% of patients with serum folate >25.7 ng/mL the sample was collected after supplementation with folic acid. Of the 128 patients with serum folate <5.5 ng/mL documentation of supplementation was present in only 38.9%. Conclusions: Serum folate levels are below the current "normal" level of 3.0 ng/mL in a larger proportion of tertiary care patients than that reported for ambulatory patients. In patients with folate deficiency, corrective action is lacking in >60% of the patients. Since serum folate levels ≥13.0 ng/mL are needed for optimal prevention of neural tube defects in the embryo/fetus, we propose that normal serum folate level should be designated to be ≥ 13.0 ng/mL.

AB - Objective: Assess the need for folate testing, frequency of corrective action, and determine reference level for serum folate. Methods: Serum folate levels in 5313 samples from 4448 patients, and clinical data were reviewed for patient characteristics and for (a) evidence of corrective action in patients with serum folate values <5.5 ng/mL, and (b) differences in patients with serum folate levels <5.5 ng/mL and patients with levels >25.7 ng/mL. Results: The prevalence of serum folate levels, in patients, <3.0, <4.0, <5.5, <7.0 and <13.0 ng/mL was 0.58%, 1.55%, 4.9%, 9.98% and 43.21% respectively. Patients with serum folate levels <5.5 ng/mL had lower serum albumin and hemoglobin. In 64% of patients with serum folate >25.7 ng/mL the sample was collected after supplementation with folic acid. Of the 128 patients with serum folate <5.5 ng/mL documentation of supplementation was present in only 38.9%. Conclusions: Serum folate levels are below the current "normal" level of 3.0 ng/mL in a larger proportion of tertiary care patients than that reported for ambulatory patients. In patients with folate deficiency, corrective action is lacking in >60% of the patients. Since serum folate levels ≥13.0 ng/mL are needed for optimal prevention of neural tube defects in the embryo/fetus, we propose that normal serum folate level should be designated to be ≥ 13.0 ng/mL.

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