Folate deficiency anaemia

Published by Bupa’s Health Information Team, December 2011.

This factsheet is for people who have folate deficiency anaemia, or who would like information about it including the symptoms, causes and treatments..

Folate deficiency anaemia is a type of anaemia caused by not having enough folate in your body. Anaemia is a condition in which blood can’t carry enough oxygen to fully meet the needs of your body.

About folate deficiency anaemia

Folate is a B vitamin. You need folate for many important processes inside your body, including 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.

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
• looking pale
• increased breathlessness
  
• feeling your heart racing or thumping (called palpitations)

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

• a sore tongue
• indigestion
• a reduced sense of taste
• diarrhoea

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 get oxygen to your vital organs. If left untreated it can lead to problems with your heart and lungs. Having a deficiency in folate can also increase your risk of certain cancers.

Causes of folate deficiency anaemia

There are a number of causes of folate deficiency. Some of the most common causes are listed below. 

• Poor diet. Your body can't store folate, so you need to eat foods every day that contain folate to make sure your body has sufficient levels.
• Medicines. Certain epilepsy medicines and methotrexate, which is 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 a woman and become pregnant, you require more folate to meet the needs of your developing baby. If you don’t have sufficient folate intake, you may become deficient and your unborn baby may develop a neural tube defect. This happens when your unborn baby's nerves and spinal cord don't develop properly in the first months of pregnancy.

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

If your blood tests show that you have anaemia with enlarged red blood cells and low levels of folate, you could have folate deficiency anaemia.

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 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 any underlying cause can be treated. 

Self-help

If you’re not getting enough folate in your diet, your GP will give you advice on how to adjust it, or refer you to a dietitian. If your alcohol intake is excessive, he or she will suggest you reduce this.

Medicines

Your GP will also prescribe folic acid tablets. Before you start, he or she will check the levels of vitamin B12 in your blood. This is because although the treatment helps you to feel better, it 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 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're taking folic acid to treat anaemia, your GP will monitor your blood count and folate level. You will be asked to have a blood test shortly after you start taking the supplements and again about eight weeks later to confirm that you’re responding to the treatment.

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. It can result in spina bifida, which is where your baby's spine doesn’t form properly.

If you're planning to have a baby, you should take a supplement of 400 micrograms (μg) of folic acid before you become pregnant, and also in the first 12 weeks of 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 as you may need to increase your intake of folic acid during your pregnancy. See our common questions for more information.

It's also important to eat folate-rich foods, such as broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. Although liver is a good source of folate, pregnant women shouldn't eat liver or liver pâté because it contains lots of vitamin A. Large intakes of vitamin A during pregnancy are linked to an increased risk of birth defects.

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). For most people, having enough vegetables, fruit and grains will be sufficient without the need to take supplements.

Good sources of folate include broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. It's also found in small amounts in leafy green vegetables like spinach, watercress and curly kale, some fruits (especially oranges and satsumas) and liver. Folate is damaged by heat, so fruit and vegetables will contain more folate when they are raw compared to when they are cooked. Breads or breakfast cereals that have been fortified with vitamins also contain a good source of folate. Fortified means that folic acid has been added during manufacturing.

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

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

For sources and links to further information, see Resources.