Folic Acid Deficiency Anemia
A common, slowly progressive megaloblastic anemia, folic acid deficiency anemia is most prevalent in infants, adolescents, pregnant and breast-feeding females, alcoholics, elderly people, and patients with malignant or intestinal diseases.
Causes
Alcohol abuse that suppresses the metabolic effects of folate is probably the most common cause of folic acid deficiency anemia. Additional causes include:
poor diet (common in alcoholics, narcotic addicts, and elderly people who live alone)
impaired absorption (due to intestinal dysfunction from such disorders as celiac disease, tropical sprue, regional jejunitis, and bowel resection)
bacteria competing for available folic acid
excessive cooking of foods, which destroys the available nutrients
prolonged drug therapy with such drugs as anticonvulsants, estrogens, and methotrexate
increased folic acid requirements during pregnancy and in patients with neoplastic diseases and skin diseases such as exfoliative dermatitis.
Complications
Folic acid deficiency anemia produces no complications.
Assessment
The patient’s history may reveal severe, progressive fatigue, the hallmark of folic acid deficiency. Associated findings include shortness of breath, palpitations, diarrhea, nausea, anorexia, headaches, forgetfulness, and irritability. The impaired oxygen-carrying capacity of the blood from lowered hemoglobin levels may produce complaints of weakness and light-headedness.
Inspection may reveal generalized pallor and jaundice. The patient may appear wasted. Cheilosis and glossitis may be present. Folic acid deficiency anemia doesn’t cause neurologic impairment unless it’s associated with vitamin B12 deficiency.
Diagnostic tests
The Schilling test and a therapeutic trial ofvitamin B12 injections distinguish between folic acid deficiency anemia and pernicious anemia. Significant findings onblood studies include macrocytosis, decreased reticulocyte count, increased mean corpuscular volume, abnormal platelet count, and serum folate levels less than 4 mg/ml.
