Folate-deficiency anemia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 28, 2016
StartDiseasesFolate-deficiency anemia

While iron-deficiency anemia is the most common type of anemia, folate-deficiency anemia is also a type of vitamin deficiency anemia. Folate-deficiency anemia occurs when the body lacks sufficient folate, also referred to as folic acid or vitamin B9. Folate plays an important role in a variety of processes, including the production of red blood cells.


Definition & Facts

Anemia is a disorder where the body produces insufficient red blood cells. Insufficient red blood cells mean the body lacks the required protein, hemoglobin which contains iron and is responsible for transporting oxygen throughout the bloodstream. Because hemoglobin transports oxygen from the lungs to each cell of the body, the absence of hemoglobin can impair various processes.

Folate deficiency is not common in developed countries. This is evident by the 2006 USDA analysis of data conducted by the National Health and Nutrition Examination Survey. The survey data indicate that the majority of individuals in the U.S. acquire sufficient quantities of folate, though certain demographics still struggle to acquire the needed quantities.

Symptoms & Complaints

The common symptoms of folate-deficiency anemia are:


Folate is a water-soluble B vitamin which is not stored in fat cells. One has to continually consume folate as the body cannot build up folate reserves. Most of this water-soluble vitamin is excreted from the body via urine. Folate-deficiency is caused by the following factors:

  • Diet. Keeping a diet low in fresh vegetables, fruits, and fortified cereals is the chief contributor of folate-deficiency anemia. Also, overcooking fruits and vegetables destroys the essential vitamins required for folate absorption. Folate levels in the body can significantly reduce in weeks should one not ingest adequate amounts of this vitamin.
  • Disease. Many ailments negatively impact the absorption of nutrients in the gastrointestinal tract, and this can trigger folate deficiencies. These ailments include specific cancer types, kidney diseases that necessitate dialysis, celiac disease, and Crohn's disease
  • Genetic factors. Folate deficiency can be caused by hereditary factors. There are groups of people that have genetic mutations which prevent the body from properly absorbing folic acid or converting supplemental or dietary folate into its functional form, methylfolate
  • Certain medications. Specific medicine prescriptions, for instance, trimethoprim, phenytoin, sulfasalazine can lead to folate deficiency.
  • Excessive alcohol consumption. Alcohol abuse has been clinically proven to hinder folate absorption and increase folate excretion during urination.

Diagnosis & Tests

In order to diagnose folate-deficiency anemia, the physician will perform a variety of tests. A complete blood count (CBC) will be taken. This test measures the quantity of hemoglobin present in the blood (as well as the concentration of hemoglobin per red blood cell); the quantity of red blood cells in the body, also referred to as red blood cell count (as well as the blood cell size); and hematocrit, a test which measures the percentage of red blood cells to the overall volume of blood. The results of these tests might differ with altitude, but normal results should indicate the following:

  • Red blood cell count for males should be 4.7 to 6.1 million cells/mcL (cells per microliter) while for females 4.2 to 5.4 million cells/mcL.
  • White blood cell count should indicate 4,500 to 10,000 cells/mcL.
  • Hematocrit for males should be 40.7 to 50.3% while for women need to be 36.1 to 44.3%
  • Hemoglobin for males should show 13.8 to 17.2 gm/dL (grams per deciliter) whereas for females should indicate 12.1 to 15.1 gm/dL.

Red blood cell indices should appear as follows:

  • Mean corpuscular volume (MCV) (average red blood cell size): 80 to 95 femtoliter
  • MCH (hemoglobin quantity per red blood cell): 27 to 31 pg/cell (picograms/cell)
  • MCHC (hemoglobin concentration per red blood cell): 32 to 36 gm/dL.

A platelet count is also included in the complete blood count (CBC) test. A platelet count ascertains the number of platelets present in blood. Platelets are vital component of the blood that assists in clotting and are smaller compared with the red and white blood cells. If the test indicates anything below 150,000, it is considered thrombocytopenia or low platelet count, meaning an individual might bleed excessively in case of a significant cut. A platelet count below 50,000 is considered severe thrombocytopenia, and it indicates a bigger risk of excessive bleeding.

Other tests will analyze plasma folate levels and red blood cell folate levels. Folate levels in the serum (liquid portion of blood) may differ depending on an individual's recent diet. Since red blood cells store over 95% of circulating folate, a measurement of the folate levels inside RBCs may well be utilized in conjunction with the plasma test. Normal red blood cell folate levels:

  • Children: Over 160 ng/mL (nanogram/milliliter) or over 362 nmol
  • Adults: 140-628 ng/mL, or 317-1422 nmol/L (nanomole/liter)

Plasma serum folate levels:

  • Infants: 14-51 ng/mL, or 31.7-115.5 nmol/L
  • Children: 5-21 ng/mL, or 11.3-47.6 nmol/L
  • Adults: 2-20 ng/mL, or 4.5-45.3 nmol/L

Treatment & Therapy

Folic acid supplements may be prescribed by mouth or intravenously. Underlying conditions such as alcoholism will need to be treated. Medication for other conditions that causes folate deficiency may need to be altered or discontinued.

Prevention & Prophylaxis

A regimen of folic-rich foods can prevent folate-deficiency anemia. Physicians recommend that women take up 400 micrograms (mcg) of folate on a daily basis prior to getting pregnant plus during the first three months of pregnancy. Also, drinking alcohol should occur in moderation if at all. A strict adherence to a healthy diet is the best way to combat folate-deficiency, including a lot of green, leafy vegetables and citrus fruits.