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The skin and mucous membranes are often bypassed, so that pallor, abnormal pigmentation, icterus, spider nevi, petechiae, purpura, angiomas, ulcerations, palmar erythema, coarseness of hair, puffiness of the face, thinning of the lateral aspects of the eyebrows, and nail defects are missed in the rush to examine the heart and the lungs (Maakaron & Besa, 2021)

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Literature indicates that nearly one-third of psychiatric and psychogeriatric hospital admissions exhibit low red cell folate levels or decreased serum folate levels, even in the absence of anemia or macrocytosis (, )