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Folate-deficiency anemia

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

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 macrocytes. They are also called megaloblasts, when 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
  • Weight loss diets

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:

Exams and Tests

The health care provider will perform a physical exam. Tests that may be done include:

In rare cases, 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, injected into muscle, or through a vein (in rare cases). 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)

Folate-deficiency anemia most often responds well to treatment within 3 to 6 months. It will likely get better when the underlying cause of the deficiency is treated.

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:

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: Hoffman R, Benz EJ, Silberstein LE, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 39.

Kumar V, Abbas AK, Aster JC. Hematopoietic and lymphoid systems. In: Kumar V, Abbas AK, Aster JC, eds. Robbins Basic Pathology. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 12.


Review Date: 1/19/2018
Reviewed By: Richard LoCicero, MD, private practice specializing in hematology and medical oncology, Longstreet Cancer Center, Gainesville, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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