Anemia of Folate Deficiency

What is folate-deficiency anemia?

Folate deficiency is the lack of folic acid (one of the B vitamins) in the blood, which can cause a type of anemia known as megaloblastic anemia. Folic acid is a B vitamin required for the production of normal red blood cells.

What is megaloblastic anemia?

Megaloblastic anemia is a type of anemia characterized by very large red blood cells. In addition to the cells being large, the inner contents of each cell are not completely developed. This malformation causes the bone marrow to produce fewer cells, and, sometimes, the cells die earlier than the 120-day life expectancy. Instead of being round or disk-shaped, the red blood cells can be oval.

What causes folate-deficiency anemia?

This anemia is typically caused by a poor diet, in which adequate amounts of folic acid are lacking. Folic acid is present in foods such as green leafy vegetables; fresh fruits; cereals; meats, including liver; and yeast. It is also produced synthetically and added to many food items. Alcohol interferes with the absorption of folate, so people who drink excessively are at risk for folate-deficiency anemia. Folate deficiency can also be seen in certain diseases of the lower digestive tract, such as celiac disease, or in people with cancer.

Folate deficiency often occurs during pregnancy because of the increased amount of folate needed by the fetus and because it is absorbed more slowly from the mother's digestive tract during pregnancy. Vomiting from morning sickness, anorexia, and poor dietary habits also contribute to folate deficiency during pregnancy. There is an association between folate deficiency during pregnancy and neural tube defects in the developing fetus.

The inability to absorb folic acid may also be inherited. Inherited congenital folate malabsorption, a genetic problem in which infants cannot absorb folic acid in their intestines, can lead to megaloblastic anemia. This requires early intensive treatment to prevent long-term problems such as intellectual disability.

Certain medications, specifically ones that prevent seizures, such as phenytoin, primidone, and phenobarbital, can impair the absorption of folic acid. The deficiency can usually be treated with a dietary supplement.

What are the symptoms of folate-deficiency anemia?

The following are the most common symptoms of folate-deficiency anemia. However, each individual may experience symptoms differently. Symptoms may include the following:

  • Abnormal paleness or lack of color in the skin

  • Decreased appetite

  • Irritability

  • Lack of energy or tiring easily (fatigue)

  • Diarrhea

  • Smooth and tender tongue

The symptoms of folate-deficiency anemia may resemble other blood conditions or medical problems. Always consult your doctor for a diagnosis.

How is folate-deficiency anemia diagnosed?

Folate-deficiency anemia may be suspected from general findings from a complete medical history and physical examination. In addition, several blood tests can be performed to confirm the diagnosis. If the anemia is thought to be caused by a problem in the digestive tract, a barium study of the digestive system may be performed. Folate deficiency does not usually produce neurological problems; B12 deficiency does. Folate and B12 deficiency can be present at the same time. If B12 deficiency is treated with folate by mistake, the symptoms of anemia may lessen, but the neurological problems can become worse.

Treatment for folate-deficiency anemia

Specific treatment for folate-deficiency anemia will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Vitamin and mineral supplements

  • Change in diet

  • Medication

  • Treatment of the causative disease

Treatment usually involves taking an oral or injected dietary folic acid supplement for at least two to three months, in addition to eating foods high in folic acid and decreasing alcohol intake. If the disorder is caused by an absorption problem in the digestive tract, it may be necessary to treat this problem first.