Folate Deficiency Anemia

Folate deficiency anemia happens when your body doesn’t have enough folate (vitamin B9) to make healthy red blood cells. A severe folate deficiency may affect your white blood cells and platelets. This article focuses on how low folate levels affect your red blood cells.

Folate drives red blood cell production. Without it, your bone marrow makes abnormal red blood cells. These cells either become trapped in your bone marrow or die soon after entering your bloodstream. Eventually, your red blood cell levels become so low that you have anemia.

Symptoms of folate deficiency anemia

You may have the following symptoms:

• Feeling very tired and weak
• Lightheadedness or feeling like you might faint
• Skin color that’s paler than usual
• Very fast heartbeat
• Shortness of breath

Folate deficiency anemia causes

You may have this condition if the food you eat doesn’t contain enough vitamin B9 or folic acid. Folic acid is the lab-made version of folate. But it can also happen if a medical condition means you need more folate than you get from food. In some cases, folate deficiency anemia happens because your body doesn’t absorb folate. Issues that cause that include:

• Alcohol use disorder
• Certain skin conditions
• Dialysis treatment for kidney failure
• Digestive disorders
• Hemolytic anemia
• Hereditary folate malabsorption, an inherited disorder that affects your body’s ability to absorb folate
• Medications that treat seizures, infections or immune system disorders
• Pregnancy

Risk factors

Risk factors include:

• Age: People age 60 and older are more likely to have this condition.
• Access to food: People without regular access to folate-rich food have a higher risk of folate deficiency anemia.

Complications

Without treatment, this condition can cause heart issues like angina, heart attack and heart failure.

How doctors diagnose folate deficiency anemia

A healthcare provider will ask about your symptoms and your health history. They’ll do a physical exam. They may also do blood tests. For example, they may do a complete blood count to measure the number of red blood cells, white blood cells and platelets. This test also checks the amount of hemoglobin in the cells. Hemoglobin helps red blood cells carry oxygen through your body. Other blood tests may include:

• Blood tests to check folate and homocysteine levels
• Peripheral blood smear, which shows blood cells’ size and shape
• Reticulocyte count to measure the number of immature red blood cells in your blood

They may also check your vitamin B12 levels, since you can have vitamin B9 and B12 deficiency at the same time.

What is the treatment?

Treatment involves receiving vitamin B9 or folic acid supplements. You may take the supplement as a pill, a shot or through an intravenous (IV) line. Your healthcare provider may also recommend adding folate-rich foods to your meals.

When should I see my healthcare provider?

Talk to your healthcare provider if you have:

• Anemia symptoms like fatigue, weakness or feeling short of breath
• A condition like celiac disease that affects how your body absorbs folate
• Anemia symptoms that don’t go away even when you take vitamin B9 supplements as prescribed

What’s the outlook for this condition?

The outlook is good. Your anemia symptoms will be less noticeable. But it takes time for your bone marrow to make enough healthy red blood cells to ease anemia symptoms. It may be several months before your symptoms go away. An underlying condition, like a digestive disorder, will affect your prognosis. If that’s your situation, ask your healthcare provider what you can expect.

Can I prevent folate deficiency anemia?

That’s hard to say, especially if you have a condition that affects how your body absorbs folate. In general, taking the following steps may reduce your risk:

• Eat well: Check out folate-rich foods, including beef liver, leafy greens and legumes like black-eyed peas and kidney beans.
• Know your needs: Our folate needs change as we age. And females who plan to become pregnant, are pregnant or are breastfeeding should boost their folate intake. But be sure to talk to a healthcare provider before taking a vitamin B9 supplement or any other supplement.
• Cut back on alcohol: Drinking a lot of alcohol makes it hard for your body to absorb folate.