Dietary folate deficiency with normal red cell folate and circulating blasts

Area of Science:

• Hematology
• Nutritional Science
• Clinical Medicine

Background:

• Nutritional folate deficiency can cause severe megaloblastic anemia.
• Megaloblastic anemia is characterized by large, immature red blood cells.

Observation:

• A 26-year-old Pakistani woman presented with severe megaloblastic anemia 5 months postpartum.
• Peripheral blood revealed a small number of myeloblasts at presentation.
• Myeloblast count temporarily increased upon initiating folate replacement therapy.

Findings:

• The patient's condition stemmed from nutritional folate deficiency.
• A non-linear relationship exists between hematocrit and red blood cell folate concentration at very low hematocrit levels (<0.15).

Implications:

• Recognizing the clinical history is crucial for diagnosing folate deficiency anemia.
• Understanding the hematocrit-folate concentration relationship aids in managing severe anemia.
• This case highlights unusual hematological findings during folate repletion.