Anemia

Folate Deficiency

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Folate Deficiency, Folic Acid Deficiency

  • Epidemiology
  1. Rare in the United States due to fortified cereals
    1. However, due to minimal Folate stores, acute conditions may rapidly deplete Folic Acid
  • Causes
  1. Inadequate Folate intake
    1. Alcohol Abuse
    2. Elderly
    3. Vegan Diet
  2. Increased Folate utilization
    1. Pregnancy
    2. Malignancy
    3. Hemolytic Anemia
  3. Medications
    1. See Medications Affecting Folate Metabolism
  • Labs
  1. Complete Blood Count
    1. See Hemoglobin Cutoffs for Anemia
    2. See Hematocrit Cutoffs for Anemia
    3. Macrocytic Anemia (Mean Corpuscular Volume >100 um^3)
      1. MCV cutoff varies by age and per reference
  2. RBC Folate decreased
    1. Not the same as Serum Folate, which fluctuates considerably with diet
  3. Serum Vitamin B12 normal
  • Management
  1. Do not initiate Folate until B12 Deficiency ruled-out
    1. Folate supplementation masks B12 Deficiency
    2. Neurologic B12 Deficiency sequelae will progress
  2. Folic Acid 1 mg orally daily for 3 weeks or until resolved
    1. Consider Folic Acid 5 mg orally daily in high utilization states (e.g. acute Hemolytic Anemia)