USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

OB TRIAD

Folate  Deficiency  Anemia

Folate stores in the body are usually enough for 90 days. Falling hemoglobin
values occur only after folate stores have been completely depleted.

Findings may vary from none to general malaise, palpitations, and ankle edema.

Diagnosis. RBCs are macrocytic. Hemoglobin ≤10 g/dL, MCV >100, RDW

15. RBC folate levels are low. Peripheral smear may show hypersegmented
    neutrophils.

Risk factors include chronic hemolytic anemias (e.g., sickle cell disease),
anticonvulsant use (phenytoin, phenobarbital), and frequent pregnancies. Fetal
effects include increased IUGR, preterm birth, and NTD.

Prevention includes folate 0.4 mg po daily for all women and 4 mg po daily for
those at high risk for NTDs.

Treatment. Folate 1 mg po daily.

Hemoglobin  <10 g

MCV >100    μm^3

RDW >15%