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Folate-deficiency anemia

 

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

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. That 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 medicines (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 older people, 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.

Symptoms

 

Symptoms may include:

  • Fatigue
  • Headache
  • Pallor
  • Sore mouth and tongue

 

Exams and Tests

 

The health care provider 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 by mouth or through a vein. If you have low folate levels because of a problem with your intestines, you may need treatment for the rest of your life.

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

 

Outlook (Prognosis)

 

Anemia most often responds well to treatment within 2 months.

 

Possible 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

 

When to Contact a Medical Professional

 

Call your 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 they get pregnant and through the first 3 months of their pregnancy.

 

 

References

Antony AC. Megaloblastic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 164.

Antony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ Jr., Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 37.

 
  • Megaloblastic anemia - view of red blood cells

    Megaloblastic anemia - view of red blood cells - illustration

    This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.

    Megaloblastic anemia - view of red blood cells

    illustration

  • Blood cells

    Blood cells - illustration

    Blood is comprised of red blood cells, platelets, and various white blood cells.

    Blood cells

    illustration

    • Megaloblastic anemia - view of red blood cells

      Megaloblastic anemia - view of red blood cells - illustration

      This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.

      Megaloblastic anemia - view of red blood cells

      illustration

    • Blood cells

      Blood cells - illustration

      Blood is comprised of red blood cells, platelets, and various white blood cells.

      Blood cells

      illustration

    A Closer Look

     

      Tests for Folate-deficiency anemia

       

       

      Review Date: 2/1/2016

      Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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