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Folate-Deficiency Anemia

What is folate-deficiency anemia?

Folate-deficiency anemia is the lack of folic acid in the blood. Folic acid is a B vitamin that helps your body make red blood cells. If you don’t have enough red blood cells, you have anemia.

Red blood cells carry oxygen to all parts of your body. When you have anemia, your blood can’t bring enough oxygen to all your tissues and organs. Without enough oxygen, your body can’t work as well as it should.

Low levels of folic acid can cause megaloblastic anemia. With this condition, red blood cells are larger than normal. There are fewer of these cells. They are also oval-shaped, not round. Sometimes these red blood cells don’t live as long as normal red blood cells.

What causes folate-deficiency anemia?

You can develop folate-deficiency anemia if:

  • You don’t eat enough foods that have folic acid. These include green leafy vegetables, fresh fruits, fortified cereals, yeast, and meats (including liver).
  • You drink too much alcohol
  • You have certain diseases of the lower digestive tract, such as celiac disease. This type of anemia also occurs in people with cancer.
  • You take certain medicines, such as some used for seizures.
  • You are pregnant. This is because the developing baby needs more folic acid. Also, the mother absorbs it more slowly. A lack of folate during pregnancy is linked to major birth defects that affect the brain, spinal cord, and spine (neural tube defects).

Some babies are born unable to absorb folic acid. This can lead to megaloblastic anemia. With this condition, red blood cells are larger than normal. They also have a different shape. Early treatment is needed to prevent problems such as poor reasoning and learning.

Who is at risk for folate-deficiency anemia?

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

  • Don’t eat a healthy diet
  • Drink a lot of alcohol
  • Are pregnant
  • Can’t 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
  • Being grouchy (irritable)
  • 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 see your healthcare provider for a diagnosis.

How is folate-deficiency anemia diagnosed?

Your healthcare provider may think you have this type of anemia after taking your medical history and doing a physical exam. You may have several blood tests to confirm the diagnosis. You may also have a barium study if a digestive problem is the cause.

How is folate-deficiency anemia treated?

Your healthcare provider will figure out the best treatment based on:

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

Treatment may include:

  • Vitamin and mineral supplements
  • Changes in your diet
  • Medicine
  • Treating the underlying disease

You may need to take folic acid supplements for at least 2 to 3 months. These may be pills or shots (injections). Eating foods high in folic acid and cutting your alcohol intake are also important. If a digestive tract problem causes your anemia, your provider may treat that 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 doesn’t develop normally. It can cause death before or soon after birth. Or it may cause paralysis of the legs.

Key points about folate-deficiency anemia

  • Most folate-deficiency anemia is caused by a lack of folic acid in the diet.
  • Leafy vegetables, citrus fruits, beans, and whole grains are natural sources of folic acid.
  • Folate-deficiency anemia in pregnancy may cause a neural tube defect. This is when the brain or spinal cord doesn’t develop normally.
  • Treatment includes a well-balanced diet of foods with folic acid, folic acid supplements, medicines, and treating underlying diseases.

Next steps

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

  • Know the reason for your visit and what you want to happen.
  • 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 name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • 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.

Medical Reviewers:

  • Finke, Amy, RN, BSN
  • Gersten, Todd, MD