Folic Acid Deficiency Anemia

Folic acid deficiency anemia is a common, slowly progressive megaloblastic anemia. It's most prevalent in infants, adolescents, pregnant and lactating women, alcoholics, and elderly people and in people with malignant or intestinal diseases.

Causes

Alcohol abuse suppressing the metabolic effects of folate is probably the most common cause of folic acid deficiency anemia. Additional causes include:

• poor diet (common in alcoholics, narcotic addicts, elderly people who live alone, and infants, especially those with infections or diarrhea). Some adolescents whose diet consists mainly of non nutritious food develop folate deficiency.
• impaired absorption (due to intestinal dysfunction from such disorders as celiac disease, tropical sprue, regional jejunitis, and bowel resection)
• bacteria competing for available folic acid
• excessive cooking of foods, which destroys the available nutrient
• limited storage capacity in infants
• prolonged drug therapy with such drugs as anti­convulsants, estrogens, and methotrexate
• increased folic acid requirements during pregnancy; during rapid growth periods in infancy (especially in surviving premature infants); during childhood and adolescence because of consumption of folate-poor calf's milk; and in patients with neoplastic diseases and some skin diseases, such as exfoliative dermatitis.

Signs and symptoms

Signs and symptoms of folic acid deficiency anemia gradually produces clinical features similar to other megaloblastic anemias, but without neurologic manifistations of B12 deficiency. Symptoms include the following:

• progressive fatigue
• shortness of breath
• heart palpitations
• Sore mouth and tongue
• nausea
• anorexia
• headache
• fainting
• irritability
• forgetfulness
• pallor
• weakness
• weight loss

Diagnostic tests

Diagnostic procedures include blood tests to measure hemoglobin, an iron-containing compound that carries oxygen to cells throughout the body. Symptoms may be reevaluated after the patient has taken prescription folic acid supplements.

Treatment

Medical treatment consists primarily of folic acid supplements and elimination of contributing causes. Supplements may be given orally (1 to 5 mg/day) or parenterally (to patients who are severely ill, have mal­absorption, or are unable to take oral medication). Many patients respond favorably to a well-balanced diet.

Dietary treatment consists of increasing the intake of green, leafy vegetables and citrus fruits.

Prevention

Adequate dietary intake in high-risk individuals and folic acid supplementation during pregnancy may help prevent the onset of this anemia.

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