Anemia of Folate Deficiency

What is folate-deficiency anemia?

Folate deficiency is the lack of folic acid in the blood. Folic acid is a B vitamin needed to make normal red blood cells. Low levels can cause megaloblastic anemia.

Very large red blood cells characterize megaloblastic anemia. The inner contents of each cell are not fully developed. This causes the bone marrow to make fewer red blood cells. 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?

Lack of folic acid in the diet causes most anemia. Foods such as green leafy vegetables; fresh fruits; cereals; meats, including liver; and yeast contain folic acid. Many foods have folic acid added to them.

Alcohol blocks the absorption of folate. If you drink heavily, you are at risk for folate-deficiency anemia.

Folate deficiency can also happen if you have certain diseases of the lower digestive tract, such as celiac disease. It also occurs in people with cancer.

Folate deficiency is common in pregnancy. This is because the fetus needs more folic acid. Also, the mother absorbs it more slowly. There is a link between folate deficiency during pregnancy and neural tube defects in the fetus.

Some infants are born without the ability to absorb folic acid. It can lead to megaloblastic anemia. It calls for early treatment to prevent problems such as poor reasoning and learning.

Certain medicines, such as the ones that prevent seizures can impair the absorption of folic acid. This can often be resolved with a dietary supplement.

Who is at risk for folate-deficiency anemia?

You are more likely to have this type of anemia if you:

  • Do not eat a healthy diet
  • Drink a lot of alcohol
  • Are pregnant
  • Are not able to absorb folic acid
  • Are taking certain medicines, such as those used to control seizures

What are the symptoms of folate-deficiency anemia?

Symptoms may include:

  • Pale skin
  • Decreased appetite
  • Irritability
  • Lack of energy or tiring easily
  • Diarrhea
  • Smooth and tender tongue

The symptoms of folate-deficiency anemia may look like other blood conditions or health problems. Always consult your health care provider for a diagnosis.

How is folate-deficiency anemia diagnosed?

Your doctor may think you have folate-deficiency anemia after reviewing your health history and doing a physical exam. You may also have several blood tests to confirm the diagnosis. You may also have a barium study if the cause of anemia is a digestive problem.

How is folate-deficiency anemia treated?

Your health care provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment may include:

  • Vitamin and mineral supplements
  • Changes in diet
  • Medicine
  • Treatment of the underlying disease

You may need to take folic acid supplements for at least 2 to 3 months. These may be pills or injections. Eating foods high in folic acid and cutting alcohol intake are also important. If a digestive tract problem causes anemia, your provider may treat it first.

What are the complications of folate-deficiency anemia?

Folate-deficiency anemia during pregnancy may cause a neural tube defect. This is when the brain or spinal cord does not develop normally. It can cause death before or soon after birth, or paralysis of the legs.

Key points about folate-deficiency anemia

  • Not having enough folic acid in your diet causes most folate deficiency.
  • Leafy vegetables, citrus fruits, beans, and whole grains are natural sources of folic acid.
  • Folate-deficiency anemia in pregnancy can cause a neural tube defect. This can cause the brain or spinal cord not to develop normally.
  • Treatment includes a well-balanced diet of foods with folic acid, folic acid supplements, medicines, and treatment of underlying diseases.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.