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A serum folate of 3 μg/L or lower indicates deficiency. [98] Serum folate level reflects folate status, but erythrocyte folate level better reflects tissue stores after intake. An erythrocyte folate level of 140 μg/L or lower indicates inadequate folate status. Serum folate reacts more rapidly to folate intake than erythrocyte folate. [113]
This requires active folate and vitamin B 12, in order to donate a methyl group. Active folate is known as 5-methyltetrahydrofolate (5-MTHF). Another pathway for the conversion of homocysteine back to methionine also exists, involving methylation with trimethylglycine (also called betaine or abbreviated to TMG) as a methyl donor.
Methylenetetrahydrofolate reductase deficiency is the most common genetic cause of elevated serum levels of homocysteine (hyperhomocysteinemia). It is caused by genetic defects in MTHFR, which is an important enzyme in the methyl cycle. [1] Common variants of MTHFR deficiency are asymptomatic and have only minor effects on disease risk. [2]
Vitamin B 12 deficiency, even when coupled with high serum folate levels, has been found to increase overall homocysteine concentrations as well. [34] Typically, hyperhomocysteinemia is managed with vitamin B 6, vitamin B 9, and vitamin B 12 supplementation. [35]
Folate deficiency can be secondary to vitamin B 12 deficiency or a defect in homocysteine methyl transferase that leads to a "folate trap" in which is an inactive metabolite that cannot be recovered. [1] Diagnosis is typically confirmed by blood tests, including a complete blood count, and serum folate levels. [1]
Still, pH, bicarbonate and base excess show a high level of inter-method reliability between arterial and venous tests, so arterial and venous values are roughly equivalent for these. [ 44 ] Test
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The isozyme is LDH-2 which is typical of the serum and hematopoietic cells. Increased homocysteine and methylmalonic acid in Vitamin B 12 deficiency; Increased homocysteine in folate deficiency; Normal levels of both methylmalonic acid and total homocysteine rule out clinically significant cobalamin deficiency with virtual certainty. [9]