Assessment of Serum Folic Acid and Homocysteine in Thalassemia Major Patients Before and After Folic Acid Supplement Cessation (original) (raw)
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Indian Pediatrics, 2019
In light of the recommendation of folic acid supplementation in chronic hemolytic anemia, with possible supratherapeutic dosing and associated side effects, we performed this study to investigate serum folate levels in children with chronic hemolytic anemia. Methods: Phase 1 was a cross-sectional study of 134 patients in the Pediatric Hematology service, documenting daily dosage and performing serum folate levels. In phase 2, we reduced the dose to 1 mg for 148 patients and repeated the testing after six months. Results: We found very high serum folate levels with Phase 1, with 93.2% above the upper level of normal. In Phase 2, values remained high with 42.5% above the acceptable upper limit. Conclusions: Doses of folic acid given to sickle cell and thalassemia patients exceed their actual needs. This should be re-evaluated to strike a balance between benefit and harm, with close monitoring of serum folate levels.
Serum Erythrocyte Folate Levels in Thalassaemic Patients in Thailand
Scandinavian Journal of Haematology, 1979
The mean serum and adjusted red cell folate levels, as measured by microassay using Lactobacillus casei, respectively were 8.87 f SD 3.28 ,1tg/1 and 436 k SD 107 pg/l in 76 normal subjects, 4.22 f SD 2.70 !rg/l and 182 f SD 114 !cg/l in 55 patients with P-thalassaemidHb E disease and 6.36 2 SD 2.95 ,~tg/l and 320 k 158 / t g / l in 37 patients with Hb H disease. The mean serum and adjusted red cell folate values of the patients with P-thalassaemidHb E disease and the mean serum folate value of the patients with Hb H disease were significantly lower than those of the normal subjects (P < 0.001). 33 % of the P-thalassaemia/Hb E patients and 8 % of the Hb H patients showed low serum folate levels (< 3 /cg/l) whereas 84 % of the former and 45 % of the latter showed low adjusted red cell folate levels (< 270 ,~t g / l ) . The group of P-thalassaemidHb E disease with low serum folate levels had lower mean haemoglobin concentration and lower mean adjusted red cell folate level than the group with normal serum folate levels. Since the Thai diets have high folate content, the observed low serum and erythrocyte folate levels in thalassaemic patients most likely occur from massively increased erythropoiesis. Folate, 5 mg/d, is now routinely prescribed to such patients especially to those with severe anaemia.
Randomized Trial of Folic Acid Supplementation and Serum Homocysteine Levels
Archives of Internal Medicine, 2001
Background: Lowering serum homocysteine levels with folic acid is expected to reduce mortality from ischemic heart disease. Homocysteine reduction is known to be maximal at a folic acid dosage of 1 mg/d, but the effect of lower doses (relevant to food fortification) is unclear.
Iranian Journal of Kidney …, 2011
Introduction. Hyperhomocysteinemia is common in patients with chronic kidney disease. There is a direct relationship between cardiovascular mortality and increase of blood homocysteine. Folic acid is used as common treatment in such patients. Folinic acid, a shortened form of folic acid, is not affected by inhibitors of dihydrofolate reductase enzyme such as methoterxate. This study was performed to evaluate the effect of oral folinic acid on the blood homocysteine level of hemodialysis patients, in comparison with folic acid. Materials and Methods. This clinical trial was performed on 60 hemodialysis patients. The participants were divided into 2 groups to receive either 15 mg of oral folic acid or 15 mg of oral folinic acid, daily. Blood homocysteine levels were measured before dialysis and after the study period. Results. Folic acid and folinic acid decreased the blood homocysteine levels by 33.0% and 28.7%, respectively (P < .001). However, only 3 patients (6.5%) enjoyed a normalized homocysteine level. Conclusions. Our study showed that both folic and folinic acid decreased the blood homocysteine level and no meaningful difference was observed between them; therefore, we suggest they can be used interchangeably.
The Use of Folic Acid in Chronic Kidney Disease Patients With Anemia
KnE Medicine
Chronic kidney disease (CKD) is defined as decreasing kidney function (GFR < 60 ml/minute/1.73 m2 ) for more than 3 months. Anemia is a common complication of CKD due to a decrease in the hormone erythropoietin related to hemoglobin levels. One of the anemia therapies involves using folic acid. Folic acid helps the process of nucleoprotein synthesis and erythropoiesis maintenance. The objective of this study was to determine the pattern of folic acid applied to CKD patients with anemia at University of Muhammadiyah Malang General Hospital. Observational, descriptive, and retrospective data collection methods were used. The results showed that there were 17 patients (47%) with a single use of folic acid (3x1 mg, oral); the most common pattern of the two-combination was folic acid (3x1 mg, oral) and PRC (250 ml, intravenous [iv]), which was given to 11 patients (65%); and the most common pattern of threecombination was folic acid (3x1 mg, oral), Promavit® (3x1 tab, oral), and PRC (...
2010
Introduction. Hyperhomocysteinemia is common in patients with chronic kidney disease. There is a direct relationship between cardiovascular mortality and increase of blood homocysteine. Folic acid is used as common treatment in such patients. Folinic acid, a shortened form of folic acid, is not affected by inhibitors of dihydrofolate reductase enzyme such as methoterxate. This study was performed to evaluate the effect of oral folinic acid on the blood homocysteine level of hemodialysis patients, in comparison with folic acid. Materials and Methods. This clinical trial was performed on 60 hemodialysis patients. The participants were divided into 2 groups to receive either 15 mg of oral folic acid or 15 mg of oral folinic acid, daily. Blood homocysteine levels were measured before dialysis and after the study period. Results. Folic acid and folinic acid decreased the blood homocysteine levels by 33.0% and 28.7%, respectively (P < .001). However, only 3 patients (6.5%) enjoyed a no...
American Journal of Kidney Diseases, 2001
The effectiveness of intravenous folinic acid or intravenous folic acid for the treatment of hyperhomocysteinemia of hemodialysis patients is unknown. In a randomized, controlled, double-blind trial, 66 hemodialysis patients were administered either 15 mg of folic acid or an equimolar amount (16.1 mg) of folinic acid intravenously three times weekly. Normalization of total homocysteine (tHcy) plasma levels after 4 weeks of treatment was achieved in 10 patients (30.3%) in the folic-acid group and 6 patients (18.2%; P = 0.389) in the folinic-acid group (normalization at any time during the study period in 39.4% and 33.3% of the patients; P = 0.798). The relative reduction in tHcy plasma levels at week 4 was 32.2% in the folic-acid group and 34.1% in the folinic-acid group. A high baseline tHcy plasma concentration (P = 0.00001), methylanetetrahydrofolate reductase (MTHFR) 677TT/1298AA genotype (P = 0.03540), and low red blood cell folate concentrations (P = 0.02286) were associated with a better relative response to treatment. Normalization of tHcy plasma levels was dependent on a lower baseline tHcy level (P = 0.01976), younger age (P = 0.00896), and MTHFR 677TT/1298AA or 677CT/1298AC genotypes (P = 0.00208 and P = 0.02320, respectively). A 4-week course of intravenous folinic acid is not superior to intravenous folic acid in reducing elevated tHcy plasma levels in hemodialysis patients. The response to treatment is predicted by tHcy plasma level, red blood cell folate content, and MTHFR genotype.
Clinical Chemistry, 2006
Background: Treatment with folic acid and vitamin B12 appears to be effective in lowering total plasma homocysteine (tHcy) concentrations, but whether vitamin B12 alone lowers tHcy in patients with normal vitamin B12 status is unknown. The aims of the present study were to explore the effect of individual supplementation with folic acid or vitamin B12 on tHcy concentrations in hemodialysis (HD) patients and to compare changes in tHcy concentrations with MTHFR genotype. Methods: We recruited 200 HD patients (119 men) from the “Umberto I” Hospital (Frosinone, Italy) and the Dialysis Unit of University Hospital “Tor Vergata”. These patients were randomized blindly into 2 groups of 100 each. Unfortunately, during the study, 36 patients in the first group and 16 in the second group died. The first group was treated initially with vitamin B12 for 2 months and with folic acid for a following 2 months. The second group was treated initially with folic acid and then with vitamin B12. Samples...
Nutrition, 2007
Objective: We evaluated the effects of folic acid on homocysteine levels and oxidative stress in 46 stable patients on hemodialysis. Methods: This double-blind, placebo-controlled, randomized trial assessed the effects of 6 mo of 10 mg of folic acid (26 patients) or placebo (20 patients) given three times weekly after each dialysis under nurse supervision on homocysteine levels, total plasma antioxidant capacity, and hydroperoxide plasma levels. Results: Folic acid treatment normalized plasma homocysteine levels in most patients, significantly increased total plasma antioxidant capacity levels, but had no significant effect on hydroperoxide levels. Placebo treatment had no statistically significant effect on the three parameters. Conclusion: The folic acid therapy protocol effectively lowered plasma homocysteine levels and improved the total plasma antioxidant capacity in hemodialysis patients. Further studies are required to assess the usefulness of folic acid for decreasing cardiovascular mortality in patients with chronic kidney disease.