Singh Gurmukh, Hamdan Hana, Singh Vivek
Department of Pathology, Georgia Regents University Medical Center, 1120, 15th Street, BI 2008A, Augusta, GA 30912, USA.
Medical Director, HooperHolmes International Inc. 560N Rogers Road, Olathe, KS 66062, USA.
Pract Lab Med. 2015 Mar 26;1:35-41. doi: 10.1016/j.plabm.2015.03.005. eCollection 2015 Apr 1.
Assess the need for folate testing, frequency of corrective action, and determine reference level for serum folate.
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.
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%.
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.
评估叶酸检测的必要性、纠正措施的频率，并确定血清叶酸的参考水平。
回顾了4448例患者5313份样本的血清叶酸水平及临床数据，以了解患者特征以及（a）血清叶酸值<5.5 ng/mL患者的纠正措施证据，以及（b）血清叶酸水平<5.5 ng/mL患者与水平>25.7 ng/mL患者之间的差异。
患者血清叶酸水平<3.0、<4.0、<5.5、<7.0和<13.0 ng/mL的患病率分别为0.58%、1.55%、4.9%、9.98%和43.21%。血清叶酸水平<5.5 ng/mL的患者血清白蛋白和血红蛋白较低。血清叶酸>25.7 ng/mL的患者中，64%的样本是在补充叶酸后采集的。在血清叶酸<5.5 ng/mL的128例患者中，仅有38.9%有补充记录。
三级护理患者中血清叶酸水平低于目前“正常”水平3.0 ng/mL的比例高于门诊患者报告的比例。在叶酸缺乏的患者中，超过60%的患者缺乏纠正措施。由于胚胎/胎儿神经管缺陷的最佳预防需要血清叶酸水平≥13.0 ng/mL，我们建议将正常血清叶酸水平设定为≥13.0 ng/mL。
