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Folate deficiency anaemia

Key points

  • You need folate for many important processes inside your body, including making red blood cells.
  • If you’re not getting enough folate you can adjust your diet to get more, or take folic acid tablets.
  • Pregnant women need to take folate supplements to meet the needs of their developing babies.
  • You can help prevent folate deficiency anaemia by eating a healthy, balanced diet that contains enough folate.

Folate deficiency anaemia is a type of anaemia that you can get if you don't have enough folate in your body. Anaemia is a condition in which your blood can’t carry enough oxygen to meet the needs of your body.

About folate deficiency anaemia

Folate is a B vitamin (B9) and you need it for many important processes inside your body. For example, folate works closely with another B vitamin, vitamin B12, to help make DNA. DNA is the genetic material found in all human cells. Folate is also involved in making red blood cells. If you don’t have enough folate, your body won't make as many red blood cells as normal. They will also be abnormally large and won't last as long as they should do.

If you don't have enough red blood cells, your tissues and organs may not get enough oxygen. This leads to the symptoms of anaemia.

Symptoms of folate deficiency anaemia

Common symptoms of all types of anaemia include:

  • feeling tired
  • feeling short of breath
  • feeling your heart racing or thumping, which is called palpitations

If you have folate deficiency anaemia, you may also develop symptoms, such as:

  • a sore tongue
  • losing your appetite
  • diarrhoea
  • depression

These symptoms may be caused by problems other than folate deficiency anaemia. If you have any of these symptoms, see your GP for advice.

Complications of folate deficiency anaemia

If you have anaemia, your heart has to work harder to deliver oxygen to your vital organs. If you have severe folate deficiency anaemia, it may lead to heart failure. This means your heart doesn’t pump blood around your body as well as it should do.

If you don't get treatment, folate deficiency anaemia can increase your risk of cardiovascular disease and affect your fertility. Having a deficiency in folate can also increase your risk of developing certain types of cancer.

If you’re pregnant and don’t get enough folate during the first few months of pregnancy, your unborn baby may develop a neural tube defect. This can lead to a condition called spina bifida, and happens when your unborn baby's nerves and spinal cord don't develop properly.

Causes of folate deficiency anaemia

There are a number of possible causes of a folate deficiency, the most common of which are listed below.

  • Poor diet. Your body can't store folate so you need to eat foods that contain folate every day to make sure you have sufficient levels.
  • Medicines. Certain epilepsy medicines and methotrexate, a medicine used to treat rheumatoid arthritis, can interfere with the way that folate is used in your body.
  • Alcohol. Drinking too much alcohol can reduce your body's ability to absorb and use folate.
  • Bowel disease. Coeliac disease or an inflammatory bowel disease, such as Crohn's disease, can interfere with how your body absorbs folate.
  • Chronic haemolytic anaemias. These include certain inherited conditions such as thalassaemia and sickle cell anaemia, which cause red blood cells to break down too quickly. This increases your body’s need for folate and can lead to a deficiency if you don’t get enough in your diet.
  • Pregnancy. If you're pregnant, you need more folate to meet the needs of your developing baby.

Diagnosis of folate deficiency anaemia

Your GP will ask about your symptoms, and examine you. He or she may also ask you about your medical history. If your GP suspects you have anaemia, he or she will ask you to have a blood test. Your blood will be sent to a laboratory to be tested for the following.

  • A full blood count. This is to check the level of haemoglobin in your blood and how many of each of the different types of blood cell you have. It will also check the size of your red cells.
  • Vitamin B12, iron and folate. The levels of each of these will be measured to see if you have reduced levels.
  • A blood film. This involves looking at your blood under a microscope to check the size and shape of your red blood cells. It will also assess the different white cells that are present.

You may need to have further tests to help identify the cause of your anaemia.

Your GP may refer you to a haematologist (a doctor who specialises in identifying and treating conditions of the blood). Or your GP may refer you to see a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system).

Treatment of folate deficiency anaemia

Your GP will try to identify why you’re deficient in folate so that he or she can treat any underlying cause.

Self-help

If you’re not getting enough folate in your diet, your GP will give you advice on how to get more. He or she may refer you to see a dietitian. Good sources of folate include:

  • green vegetables, such as spinach, kale and broccoli
  • chickpeas
  • beans, such as blackeye beans
  • poultry and pork
  • oranges
  • brown rice

If you're drinking too much alcohol, your GP will suggest you reduce your intake and may offer you support to achieve this.

Medicines

Your GP may advise you to take folic acid supplements. You can buy supplements over-the-counter from a pharmacy or your GP may prescribe them for you. Before you start, he or she will check your levels of vitamin B12 in your blood. This is because although folic acid supplements can help you to feel better, they may hide an underlying vitamin B12 deficiency. If this happens, you may develop problems with your nervous system.

Folate comes in a synthetic (artificial) form called folic acid. This is a water-soluble vitamin that your body can use instead of folate. You will usually need to take 5 milligrams (mg) per day, for at least four months. Some people may need to take folic acid for a long time, sometimes for the rest of their life. Always read the patient information leaflet that comes with your supplements and if you have any questions, ask your GP or pharmacist for advice.

If you take folic acid to treat anaemia, your GP will monitor your blood count and folate level. You will have a blood test about eight weeks after you start taking supplements. You will then have another blood test at the end of your treatment to confirm that you responded to it.

Special considerations

If you're pregnant and don't get enough folate in your diet, there is an increased risk of your baby developing a neural tube defect. This can result in a condition called spina bifida, which is when your baby's spine doesn’t form properly.

If you're trying to get pregnant, take a supplement of 400 micrograms (μg) of folic acid every day from when you start trying. Continue to take it in the first 12 weeks of your pregnancy. This will help to reduce the risk of your baby having a neural tube defect. If you have previously had a child with this problem, ask your GP for advice. You will need to increase your intake of folic acid during your pregnancy. See our FAQs for more information.

It's also important to eat folate-rich foods but don't eat liver. Although it's a good source of folate, it's not suitable for pregnant women because it contains lots of vitamin A, which can harm your baby.

Prevention of folate deficiency anaemia

You can reduce your risk of developing folate deficiency anaemia by eating a healthy, balanced diet that contains enough folate. The recommended daily amount for adults is 200 micrograms (μg). Most people get enough folate from eating enough vegetables, fruit and grains, and don't need to take supplements.

Folate is damaged by heat, so fruit and vegetables contain more folate when they are raw compared to when they are cooked. Breads or breakfast cereals that have been fortified with vitamins are also a good source of folate. Fortified means that folic acid has been added during manufacturing.

If you have a condition that affects how you absorb nutrients, or if you’re pregnant, you may need to take supplements. Ask your GP for advice.

 

Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, November 2013.

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For answers to frequently asked questions on this topic, see FAQs.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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