Folic acid deficiency anemia

A common, slowly progressive megaloblastic anemia, folic acid deficiency anemia is most prevalent in infants, adolescents, pregnant and lactating females, alcoholics, elderly people, and people with malignant or intestinal diseases.

Causes

Folic acid deficiency anemia results from a decreased level or lack of folate, a vitamin that’s essential for red blood cell production and maturation. Causes include:

❑ alcohol abuse (may suppress metabolic effects of folate)

❑ inadequate diet (common in alcoholics, elderly people who live alone, and infants, especially those with infections or diarrhea)

❑ impaired absorption (due to intestinal dysfunction from such disorders as celiac disease, tropical sprue, and regional jejunitis and from bowel resection)

❑ bacteria competing for available folic acid

❑ overcooking, which can destroy a high percentage of folic acids in foods

❑ limited storage capacity in infants

❑ prolonged drug therapy (with anticonvulsants and estrogens)

❑ increased folic acid requirement during pregnancy, during rapid growth in infancy (common because of increased survival rate of preterm infants), during childhood and adolescence (because of general use of folate-poor cow’s milk), and in patients with neoplastic diseases and some skin diseases (chronic exfoliative dermatitis).

Signs and symptoms

Folic acid deficiency anemia gradually produces clinical features that are characteristic of other megaloblastic anemias without the neurologic manifestations. These include progressive fatigue, dyspnea, palpitations, weakness, glossitis, nausea, anorexia, headache, fainting, irritability, forgetfulness, pallor, and slight jaundice.

Folic acid deficiency anemia doesn’t cause neurologic impairment unless it’s associated with vitamin B₁₂ deficiency, as in pernicious anemia.

Diagnosis

The Schilling test and a therapeutic trial of vitamin B₁₂ injections help distinguish between folic acid deficiency anemia and pernicious anemia. Significant findings include macrocytosis, a decreased reticulocyte count, low platelet count, and a serum folate level less than 4 mg/ml.

Treatment

Folic acid supplements and the elimination of contributing causes are the primary treatments. Supplements may be given orally (usually 1 to 5 mg/day) or parenterally (to patients who are severely ill, have malabsorption, or are unable to take oral medication).

Clinical tip The clinical features of anemia usually disappear within 1 to 2 weeks after administration of folate.

Many patients also respond favorably to a well-balanced diet.

If the patient has combined vitamin B₁₂ and folate deficiencies, folic acid replenishment alone may aggravate neurologic dysfunction.

Special considerations

❑ Encourage the patient to meet daily folic acid requirements by including a food from each food group in every meal.

❑ If the patient has a severe deficiency, explain that diet only reinforces folic acid supplementation but isn’t therapeutic by itself.

❑ Urge compliance with the prescribed course of therapy. Advise the patient not to stop taking the supplements when he begins to feel better.

❑ Emphasize the importance of good oral hygiene for the patient with glossitis. Suggest regular use of mild or diluted mouthwash and a soft toothbrush. Oral anesthetics may reduce discomfort.

❑ Monitor fluid and electrolyte balance, particularly in the patient who has severe diarrhea and is receiving parenteral fluid replacement therapy.

❑ Because anemia causes severe fatigue, schedule regular rest periods until the patient can resume normal activity.

❑ To prevent folic acid deficiency anemia, emphasize the importance of a well-balanced diet high in folic acid (dark green, leafy vegetables, organ meats, eggs, milk, oranges, bananas, dry beans, and whole grains). Identify alcoholics with poor dietary habits, and try to arrange for appropriate counseling.

❑ Tell mothers who aren’t breast-feeding to use commercially prepared formulas.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Anemia

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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.

More About Causes of Anemia

• Back to symptom: Anemia: Introduction (review 810 causes)
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More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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