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

Folate, also called folic acid, is necessary for red blood cell formation and growth. You can get folate by eating green leafy vegetables and liver. Some medications, such as phenytoin (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 called megalocytes, or megaloblasts in the bone marrow. Subsequently, this anemia may be referred to as megaloblastic anemia

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

Risk factors include poor diet (seen frequently in the poor, the elderly, and people who do not eat fresh fruits or vegetables), eating overcooked food, alcoholism (which interferes with the absorption of folate), history of malabsorption diseases, and pregnancy. The disease occurs in about 4 out of 100,000 people.

• Tiredness
• Headache
• Sore mouth and tongue
• Pallor

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

The goal is to treat the cause of the anemia, which may be poor diet 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.

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.

Call for an appointment with your health care provider if you have symptoms of folate deficiency anemia.

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