Folate-deficiency anemia

Answer 1

Definition

Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate.

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Causes, incidence, and risk factors

Folate, also called folic acid, is necessary for red blood cell formation and growth. You can get folate by eating green leafy vegetables and liver. Because folate is not stored in the body in large amounts, you need to get a continual supply of this vitamin through diet to maintain normal levels.

In folate-deficiency anemia, the red cells are abnormally large. These large cells are called megalocytes, or megaloblasts in the bone marrow. That is why this anemia can also be called megaloblastic anemia.

Causes of this anemia are:

• Certain medications (such as phenytoin [Dilantin], alcohol, methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates)
• Chronic alcoholism
• Crohn's disease, celiac disease, infection with the fish tapeworm, or other problems that make it difficult for your body to digest foods
• Poor dietary intake of folic acid
• Surgeries that remove certain parts of your stomach or small intestine, such as some weight-loss surgeries

In the third trimester of pregnancy, a woman may have a deficiency due to an increased need for folic acid. Hemolytic anemia can also cause a deficiency due to increased red blood cell destruction and increased need.

Risk factors include:

• Alcoholism (which interferes with the absorption of folate)
• Eating overcooked food
• Poor diet (often seen in the poor, the elderly, and people who do not eat fresh fruits or vegetables)
• Pregnancy

The disease occurs in about 4 out of 100,000 people.

Symptoms

• Fatigue
• Headache
• Pallor
• Sore mouth and tongue

Signs and tests

• Bone marrow examination (rarely necessary)
• Complete blood count (CBC)
• Red blood cell folate level

Treatment

The goal is to identify and treat the cause of the folate deficiency.

Folic acid supplements may be given by mouth (oral) or through a vein (intravenous) on a short-term basis until the anemia has been corrected. In the case of poor absorption by the intestine -- replacement therapy may be lifelong.

Dietary treatment consists of increasing the intake of green, leafy vegetables and citrus fruits.

Expectations (prognosis)

Anemia usually responds well to treatment within 2 months.

Complications

Symptoms of anemia can cause discomfort. In pregnant women, folate deficiency has been associated with neural tube or spinal defects (such as spina bifida) in the infant.

Other, more severe complications may include:

• Curly graying hair
• Increased skin color (pigment)
• Infertility
• Worsening of Heart disease or heart failure

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of folate deficiency anemia.

Prevention

Good dietary intake of folate in high-risk individuals, and folic acid supplementation during pregnancy may help prevent this anemia.

References

Antony AC. Megoblastic anemias. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 39.

Kaferie J, Strzoda CE. Evaluation of macrocytosis. Am Fam Physician. 2009;79:203-208.

Answer 2

Definition

Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid.

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Causes, incidence, and risk factors

Folate (folic acid) is needed for red blood cells to form and grow. You can get folate by eating green leafy vegetables and liver. However, your body does not store folate in large amounts. So, you need to eat plenty of folate-rich foods to maintain normal levels of this vitamin.

In folate-deficiency anemia, the red blood cells are abnormally large. Such cells are called megalocytes. They are also called megaloblasts. They are seen in the bone marrow. This is why this anemia is also called megaloblastic anemia.

Causes of this type of anemia include:

• Too little folic acid in your diet
• Hemolytic anemia
• Long-term alcoholism
• Use of certain medications (such as phenytoin [Dilantin], methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates)

The following raise your risk for this type of anemia:

• Alcoholism
• Eating overcooked food
• Poor diet (often seen in the poor, the elderly, and people who do not eat fresh fruits or vegetables)
• Pregnancy

Folic acid is needed to help a baby in the womb grow properly. Too little folic acid during pregnancy may lead to birth defects in a baby. For more information see: Folic acid and birth defect prevention

Symptoms

• Fatigue
• Headache
• Pallor
• Sore mouth and tongue

Signs and testsThe doctor or nurse will perform a physical exam. Tests that may be done include:

• Complete blood count (CBC)
• Red blood cell folate level

Rarely, a bone marrow examination may be done.

Treatment

The goal is to identify and treat the cause of the folate deficiency.

You may receive folic acid supplements, taken by mouth or given through a vein. If you have low folate levels because of a problem with your intestines, you make need treatment for the rest of your life.

Diet changes can help boost your folate level. Eat more green, leafy vegetables and citrus fruits.

Expectations (prognosis)

Anemia usually responds well to treatment within 2 months.

Complications

Symptoms of anemia can cause discomfort. In pregnant women, folate deficiency has been associated with neural tube or spinal defects (such as spina bifida) in the infant.

Other, more severe complications may include:

• Curly graying hair
• Increased skin color (pigment)
• Infertility
• Worsening of heart disease or heart failure

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of folate deficiency anemia.

Prevention

Eating plenty of folate rich foods can help prevent this condition.

Experts recommend that women take 400 micrograms (mcg) of folic acid every day before you get pregnant through the first 3 months of pregnancy.

References

Antony AC. Megaloblastic anemias. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 167.

Reviewed By

Review Date: 02/08/2012

Todd Gersten, MD, Hematology/Oncology, Palm Beach Cancer Institute, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.