Inpatient folate testing at an academic cancer center: single-year experience

Laboratory evaluation of folate deficiency among inpatients with cancer

“…With widespread dietary fortification with folic acid since 1998, folate deficiency is rare, as demonstrated in numerous research studies performed across many care settings. 1,2 However, we recently demonstrated that in hospitalized cancer patients, 7% of folate tests showed deficiency, 3 considerably higher than in the general population. We now evaluate the laboratory parameters characteristic of folate deficiency in hospitalized cancer patients, to possibly guide more directed testing.…”

“…3 Study details have previously been published. 3 We queried potential risk factors for folate deficiency, including hemolysis, medications (pyrimethamine, trimethoprim, phenytoin, valproate, sulfasalazine, carbamazepine, methotrexate, and cholestyramine), gastrointestinal malabsorption (prior gastric bypass surgery, Crohn's disease, small bowel resection, or celiac disease), use of hemodialysis, malnutrition (body mass index < 18), and alcoholism (when quantified, >3 drinks per day). For medications, we set a threshold of having received ≥5 doses in the preceding month or ≥1 dose of intravenous methotrexate.…”

“…We have recently published that folate deficiency is found in 7% of tests when performed in hospitalized cancer patients. 3 In an effort to provide guidance for choosing wisely when folate tests should or should not be performed, we evaluated the association between macrocytosis and folate deficiency in the inpatient oncology setting and analyzed all inpatient folate testing for a one-year period at our institution, a large cancer center. No association was found between MCV and folate deficiency within our study population, which was relatively enriched for patients with folate deficiency (overall rate 7%).…”