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Folic Acid Deficiency Anaemia – Causes, Symptoms and Treatment

Folic acid deficiency anaemia is a type of blood disorder caused by insufficient folate (vitamin B9), impairing the production of healthy red blood cells.

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Things worth knowing about "Folic Acid Deficiency Anaemia"

Folic acid deficiency anaemia is a type of blood disorder caused by insufficient folate (vitamin B9), impairing the production of healthy red blood cells.

What is Folic Acid Deficiency Anaemia?

Folic acid deficiency anaemia is a form of megaloblastic anaemia in which insufficient levels of folic acid (vitamin B9) prevent the bone marrow from producing an adequate number of functional red blood cells. The red blood cells that are produced are abnormally large (megaloblasts) but functionally impaired. Folic acid is a water-soluble B vitamin that is essential for DNA synthesis and cell division.

Causes

A deficiency in folic acid can arise from several factors:

Inadequate dietary intake: A diet low in folate-rich foods such as vegetables and legumes.
Increased requirements: During pregnancy and breastfeeding, the demand for folic acid increases significantly.
Malabsorption: Conditions such as coeliac disease or Crohn's disease can impair folate absorption in the small intestine.
Alcohol misuse: Alcohol interferes with the absorption and metabolism of folic acid.
Medications: Certain drugs such as methotrexate, phenytoin, or trimethoprim can disrupt folate metabolism.
Haemodialysis: Patients undergoing dialysis lose folic acid during the dialysis process.

Symptoms

Symptoms typically develop gradually and may include:

Persistent fatigue and weakness
Pale skin and mucous membranes
Shortness of breath on exertion
Heart palpitations
Headaches and dizziness
Inflammation of the mouth lining and tongue (glossitis)
Difficulty concentrating and irritability

Unlike vitamin B12 deficiency anaemia, folic acid deficiency anaemia does not typically cause neurological damage.

Diagnosis

Diagnosis is based on clinical evaluation and laboratory tests:

Full blood count: Reveals abnormally large red blood cells (macrocytosis, megaloblastic changes) and elevated mean corpuscular volume (MCV).
Serum folate level: A level below 2.5 ng/ml indicates deficiency.
Red cell folate: Reflects long-term folate status more accurately than serum levels.
Vitamin B12 level: Measured to exclude concurrent vitamin B12 deficiency, which presents with similar blood count changes.
Homocysteine: Elevated homocysteine levels may indicate folic acid deficiency.

Treatment

Treatment depends on the underlying cause and typically includes:

Folic Acid Supplementation

The standard treatment involves oral administration of folic acid, typically 1–5 mg per day. The duration of treatment depends on the underlying cause. In most cases, blood counts normalise within 4–8 weeks.

Dietary Adjustment

A folate-rich diet including foods such as green leafy vegetables (spinach, broccoli), legumes, wholegrains, liver, and eggs is recommended to support treatment and prevent recurrence.

Treating the Underlying Condition

In cases of malabsorption syndromes or chronic disease, the underlying condition must also be managed to prevent a recurring deficiency.

Special Considerations

For women who are planning a pregnancy, the World Health Organization (WHO) and national health authorities recommend a daily folic acid supplement of 400 µg starting before conception and continuing through the first trimester to reduce the risk of neural tube defects in the baby.

References

World Health Organization (WHO): Nutritional anaemias: tools for effective prevention and control. Geneva: WHO Press, 2017.
Stabler SP. Vitamin B12 Deficiency. New England Journal of Medicine. 2013;368:149-160.
Green R, et al. Folate. In: Modern Nutrition in Health and Disease, 11th ed. Lippincott Williams and Wilkins, 2014.

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