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D52.8 – Other Folate Deficiency Anaemia
D52.8 is the ICD-10 code for other folate deficiency anaemia. A lack of folic acid impairs red blood cell production, leading to enlarged, immature red blood cells.
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D52.8 is the ICD-10 code for other folate deficiency anaemia. A lack of folic acid impairs red blood cell production, leading to enlarged, immature red blood cells.
What is D52.8?
The ICD-10 code D52.8 refers to other folate deficiency anaemia – forms of anaemia caused by a deficiency of folic acid (vitamin B9) that are not classified elsewhere. Folic acid is an essential B-vitamin required for cell division and the production of red blood cells. When this vitamin is lacking, abnormally large and immature red blood cells (macrocytes) are formed that cannot effectively transport oxygen. This type of anaemia is also known as megaloblastic anaemia.
Causes
The folate deficiency leading to a D52.8 diagnosis can have several causes:
- Dietary: Insufficient intake of folic acid, for example due to a poor diet or chronic alcohol misuse.
- Drug-induced: Certain medications such as methotrexate, phenytoin, or trimethoprim can interfere with folate metabolism.
- Increased demand: Pregnancy, breastfeeding, haemolytic anaemias, or chronic inflammatory conditions increase the body's need for folate.
- Malabsorption: Conditions affecting the small intestine such as coeliac disease or Crohn's disease can impair folate absorption.
- Other causes: Renal disease requiring dialysis or certain metabolic disorders.
Symptoms
The symptoms of folate deficiency anaemia usually develop gradually and may include:
- Fatigue, weakness, and general lethargy
- Pallor of the skin and mucous membranes
- Shortness of breath and increased heart rate on exertion
- Headaches and difficulty concentrating
- Inflammation of the oral mucosa (stomatitis) or tongue (glossitis)
- Loss of appetite and weight loss
Unlike vitamin B12 deficiency anaemia, pure folate deficiency does not cause neurological symptoms.
Diagnosis
The diagnosis of folate deficiency anaemia is established through:
- Full blood count: Detection of enlarged red blood cells (elevated MCV, macrocytosis) and hypersegmented neutrophils.
- Serum folate: Low folic acid levels in the blood (< 2.5 – 3 ng/ml depending on the laboratory).
- Red cell folate: Provides information about long-term folate status (a more sensitive marker).
- Vitamin B12 level: To exclude a combined deficiency anaemia.
- Homocysteine level: Elevated homocysteine in the blood may indicate folate deficiency.
Treatment
Treatment depends on the underlying cause:
- Folic acid supplementation: Oral administration of folic acid (usually 1 – 5 mg daily), or parenteral administration in severe cases. Treatment duration ranges from several weeks to months depending on the cause.
- Dietary adjustment: Increased intake of folate-rich foods (dark green leafy vegetables, legumes, whole grains, liver).
- Treatment of the underlying condition: For example, managing malabsorption, discontinuing causative medications, or addressing alcohol misuse.
- Prophylaxis in pregnancy: Women who are planning a pregnancy are advised to take a daily folic acid supplement (0.4 mg/day) to prevent neural tube defects.
Important Note
Before starting folic acid therapy, it is essential to rule out a vitamin B12 deficiency. Administering folic acid alone in the presence of a concurrent B12 deficiency may improve haematological symptoms but can mask and worsen underlying neurological damage.
References
- World Health Organization (WHO): Nutritional Anaemias: Tools for Effective Prevention and Control. Geneva, 2017.
- Kasper DL et al.: Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.
- Green R et al.: Folate deficiency and megaloblastic anaemia. In: Blood, the Journal of the American Society of Hematology. 2017. Available at: pubmed.ncbi.nlm.nih.gov
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