Folate-deficiency anemia

Folate-deficiency anemia is a decrease in red blood cells (anemia) caused by folate deficiency.

Causes, incidence, and risk factors

Folate, also called folic acid, is necessary for red blood cell formation and growth. Folate can be obtained from green leafy vegetables and liver. Some medications, such as Dilantin, interfere with the absorption of this vitamin. Because folate is not stored in the body in large amounts, a continual dietary supply of this vitamin is needed.

In folate deficiency anemia, the red cells are abnormally large and are referred to as megalocytes, and in the bone marrow as megaloblasts. Subsequently, this anemia may be referred to as megaloblastic anemia

Causes of the anemia are poor dietary intake of folic acid as in chronic alcoholism, malabsorption diseases such as celiac disease and sprue, and certain medications. A relative deficiency due to increased need for folic acid may occur in the third trimester of pregnancy.

Risk factors are a poor diet (seen frequently in the poor, the elderly, and in people who do not buy fresh fruits or vegetables), overcooking food, alcoholism, having a history of malabsorption diseases, and pregnancy. The disease occurs in about 4 out of 100,000 people.


  • Tiredness  
  • Headache  
  • Sore mouth and tongue  
  • Pallor

Signs and tests

  • Low red blood cell folate level.  
  • A complete blood count shows anemia and large red blood cells.  
  • A bone marrow examination is rarely necessary, but shows megaloblasts.

The goal is to treat the underlying cause of the anemia, which may be dietary or a malabsorption disease.

Oral or intravenous folic acid supplements may be taken on a short-term basis until the anemia has been corrected, or in the case of poor absorption by the intestine, replacement therapy may be lifelong.

Dietary treatment consists of increasing the intake of green leafy vegetables and citrus fruits.

Expectations (prognosis)
Anemia usually responds well to treatment within 2 months.

Symptoms of anemia can cause discomfort. In a pregnant woman, folate deficiency has been associated with neural tube or spinal defects (such as spina bifida) in the infant.

Calling your health care provider
Call for an appointment with your health care provider if symptoms indicate anemia of folate deficiency may be present.

Adequate dietary intake in high-risk individuals and folic acid supplementation during pregnancy may help prevent the onset of this anemia.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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