Folate, also known as vitamin B9, is a co-factor necessary for DNA synthesis. Folate deficiency is associated mainly with hematological findings including megaloblastic anemia and pancytopenia. Many countries have mandated grain fortification with micronutrients including folic acid resulting in a reduced prevalence of folate deficiency. Saudi Arabia imports most of the grain products and folate is usually added after milling. There are no local studies to address the folate deficiency prevalence. In this study we aimed to analyse the clinical appropriateness of ordering practice of serum Folate level.

Method

We reviewed all serum folate requests received at our laboratory in Aseer Central Hospital over one-year period (July 2018 June 2019). We collected patients’ demographics from the electronic requests along with biochemical results of serum B12, ferritin and CBC results. We assessed appropriateness of orders against pre-specified criteria and applied statistical tests to explore for any association or significance.

Results

Serum folate requests from 614 patients were received during the study period. Serum B12 (543, 88%), and serum ferritin (511, 83%) were concurrently requested. The most common reason for request, when available, was anemia. Anemia was present in (313, 51%) of the subjects for which microcytic anemia was predominant (199, 63.5%), followed by normocytic anemia (101, 33%) and only 10 subjects had macrocytic anemia (3.2%). The most common hematinics’ deficiency was ferritin (30%) followed by B12 (17.2%). Serum folate deficiency was low, observed in only 2.8%. Low folate levels were not significantly different between the group with anemia and the normal hemoglobin group.

Conclusion

This study identifies a commonly inappropriate serum folate ordering practice that includes ordering all hematinics at the same visit without considering the possible anemia etiologies. The excessive requests might be related to doctors attempt to avoid multiple blood extractions and to try to reduce the time for diagnosis. These policies are generating unnecessary costs and time loss. Education, phasing out or restricting some tests and introducing laboratory policies like sample storing could help reduce unnecessary requests.

中文翻译：

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沙特阿拉伯一家三级医院血清叶酸订购模式的临床适用性。

叶酸，也称为维生素 B9，是 DNA 合成所必需的辅助因子。叶酸缺乏主要与血液学发现有关，包括巨幼细胞性贫血和全血细胞减少症。许多国家已强制使用包括叶酸在内的微量营养素强化谷物，从而降低叶酸缺乏症的患病率。沙特阿拉伯进口大部分谷物产品，叶酸通常在碾磨后添加。没有本地研究来解决叶酸缺乏症的患病率。在本研究中，我们旨在分析血清叶酸水平排序实践的临床适用性。

方法

我们审查了一年内（2018 年 7 月至 2019 年 6 月）我们在 Aseer 中心医院的实验室收到的所有血清叶酸请求。我们从电子请求中收集了患者的人口统计数据以及血清 B12、铁蛋白和 CBC 结果的生化结果。我们根据预先指定的标准评估订单的适当性，并应用统计测试来探索任何关联或意义。

结果

在研究期间收到了来自 614 名患者的血清叶酸请求。同时要求提供血清 B12 (543, 88%) 和血清铁蛋白 (511, 83%)。如果有的话，最常见的请求原因是贫血。(313, 51%) 受试者出现贫血，其中以小红细胞性贫血为主 (199, 63.5%)，其次是正细胞性贫血 (101, 33%)，只有 10 名受试者患有大红细胞性贫血 (3.2%)。最常见的血色素缺乏症是铁蛋白 (30%)，其次是 B12 (17.2%)。血清叶酸缺乏症很低，仅观察到 2.8%。贫血组和正常血红蛋白组之间的低叶酸水平没有显着差异。

结论

本研究确定了一种常见的不适当的血清叶酸订购做法，包括在同一次就诊时订购所有血红素，而不考虑可能的贫血病因。过多的要求可能与医生试图避免多次抽血并试图减少诊断时间有关。这些政策正在产生不必要的成本和时间损失。教育、逐步取消或限制某些测试以及引入样本储存等实验室政策可能有助于减少不必要的要求。