Anemia, Folic Acid Deficiency

General Illness Information


Common Name:

ANEMIA, FOLIC ACID DEFICIENCY

Medical Term: None Specified

Description:

Folic acid anemia is a megaloblastic anemia caused by lack of folic acid. In this type of anemia, bone marrow produces large, abnormal red blood cells (megaloblasts). It is often accompanied by iron-deficiency anemia. Folic acid is a vitamin found in raw vegetables, fresh fruit and meats and is destroyed by cooking. It is stored in the liver- but in very small quantities. Therefore a diet lacking in folic acid leads to a deficiency within a few months.

Causes:

  • Malnutrition;
  • Inadequate folate intake;
  • Malabsorption of folate;
  • Increased demand for folate;
  • Medications causing folate deficiency.

Prevention:

  • Stop alcohol consumption. Have regular medical checkups during pregnancy. Take prenatal vitamin supplements, which contain folic acid -if pregnant, or planning a pregnancy. Folic acid is recommended in the first few weeks of pregnancy, as studies show that folic acid taken in the first few weeks of pregnancy reduces the incidence of Down’s syndrome and of spina bifida in the baby;
  • Eat well. Include fresh vegetables, meat and other animal proteins. Avoid fad diets. Don’t overcook food. Stop smoking. Smoking increases vitamin requirements.

Signs & Symptoms

  • Blackheads (black spots the size of a pinhead);
  • Fatigue and weakness;
  • Paleness;
  • Red, sore tongue;
  • Shortness of breath;
  • Nausea, vomiting and diarrhea (rare);
  • Neurologic abnormalities – only in infants. Folic acid deficiency in pregnant women can cause spinal cord defects and other malformations.

Risk Factors

  • Adults over 60, especially those who have poor nutrition;
  • Pregnancy;
  • Illness, such as tropical sprue (celiac disease), psoriasis, acne rosacea, eczema or dermatitis herpetiformis;
  • Fad diets or general poor nutrition, especially vitamin C deficiency;
  • Surgical removal of the stomach;
  • Smoking, which decreases vitamin C absorption. Vitamin C is necessary for folic acid absorption;
  • Use of certain drugs, such as oral contraceptives, anticonvulsants, methotrexate, triamterene or sulfasalazine.

Diagnosis & Treatment

General Measures:

  • Diagnostic tests include laboratory blood studies, a Schilling test to measure vitamin B-12 levels, folic acid levels in the blood. Both folic acid and vitamin B 12 deficiency present with megaloblastic anemia. In megaloblastic anemia it is very important to rule out vitamin B 12 deficiency before treating with folate, which will alleviate the anemia but allow the associated neurologic damage to progress. Treatment consists mainly of folic acid supplements and elimination of contributing causes;
  • If you smoke, stop smoking;
  • If you take oral contraceptives, consider using another form of contraception;
  • Stop alcohol.

Medications:

Folic acid supplements- 1mg per day. Normal daily requirement is 50 micrograms per day, with 2 to 3 times that amount is required in pregnancy and childhood.

Activity:

Schedule regular rest periods until you are able to resume normal activity.

Diet:

  • No special diet;
  • Eat foods daily that are high in folic acid. The liver can store folic acid for a limited period of time (2 to 4 months). Foods include asparagus spears, beef liver, broccoli spears, collards (cooked), mushrooms, oatmeal, peanut butter, red beans and wheat germ.

Possible Complications:

  • Infertility;
  • Increased susceptibility to infection;
  • Congestive heart failure (severe cases only);
  • In pregnancy may cause neurologic abnormalities in the fetus.

Prognosis

Usually reversible in three to four weeks with an adequate folic acid intake.

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