Folic Acid Deficiency Anaemia

Understanding blood

Blood is made up of a fluid called plasma which contains:

• Red blood cells - which take oxygen around the body.
• White blood cells - which are part of the immune system, and defend the body from infection.
• Platelets - which help the blood to clot if we cut ourselves.
• Proteins - and other chemicals that have various functions.

Red blood cells are made in the bone marrow, and millions are released into the bloodstream each day. A constant new supply of red blood cells is needed to replace old cells that break down. Red blood cells contain a chemical called haemoglobin. Haemoglobin binds to oxygen and takes oxygen from the lungs to all parts of the body.

To constantly make red blood cells and haemoglobin you need a healthy bone marrow and nutrients such as iron and certain vitamins, including folic acid, which we get from food.

What is anaemia and folic acid deficiency anaemia?

Anaemia means that:

• you have fewer red blood cells than normal, OR
• you have less haemoglobin than normal in each red blood cell.

In either case, a reduced amount of oxygen is carried around in the bloodstream. There are a number of different causes of anaemia (such as lack of iron or certain vitamins).

Folic acid is a vitamin and is needed to make new cells in the body, including red blood cells. The body does not store very much folic acid. You need a regular fresh supply to keep healthy. Many foods contain folic acid including spinach, sprouts, broccoli, green beans, peas, chickpeas, brown rice, kidney, liver and potatoes. A normal balanced diet contains enough folic acid. However, a lack of folic acid will cause anaemia, and sometimes other symptoms.

A blood test can confirm anaemia due to folic acid deficiency.

What are the symptoms of folic acid deficiency?

Symptoms due to anaemia are caused by the reduced amount of oxygen in the body.

• Common symptoms include: tiredness, lethargy, feeling faint, becoming easily breathless.
• Less common symptoms include: headaches, palpitations, altered taste and ringing in the ears (tinnitus).
• You may look pale.

Other symptoms include a sore mouth and tongue.

What are the causes of folic acid deficiency?

• Not eating enough foods with folic acid is the commonest cause. This occurs most often in elderly people who do not eat well. Another group who often don't eat properly are people who are alcohol dependent.
• Pregnancy causes reserves of folic acid in your body to be used by the growing baby. You are at risk of becoming low in folic acid during the later stages of pregnancy, particularly if you do not eat well during pregnancy.
• Some uncommon conditions of the gut may cause poor absorption of folic acid. For example, coeliac disease.
• Some blood disorders can lead to a very high turnover of red blood cells. For example sickle cell disease and thalassaemia. Normal amounts of folic acid in the diet may then not be enough, and supplements may need to be taken.
• Some medicines interfere with folic acid. Therefore, you may need to take extra folic acid whilst taking certain medicines. For example, cholestyramine, sulphasalazine, methotrexate and some anticonvulsant medicines used to treat epilepsy.

What is the treatment for folic acid deficiency?

Treatment is easy and is by taking a tablet of folic acid each day. You need to take this until the anaemia is corrected and the folic acid stores in the body are built up (usually for about four months). You may need advice on diet to stay well, and the tablets can be stopped if your diet improves. You may need to continue with treatment if a poor diet was not the cause of folic acid deficiency. For example, if you have sickle cell disease you may need a folic acid tablet each day indefinitely.

Folic acid and pregnancy

Extra folic acid is advised for at least the first 12 weeks of pregnancy for all women - even if you are healthy and have a good diet. If you take extra folic acid in early pregnancy you have less chance of having a baby born with a spinal cord problem such as spina bifida. It is best to start taking the extra folic acid before becoming pregnant. If the pregnancy is unplanned then start taking folic acid as soon as you know you are pregnant. You can buy folic acid tablets at most health food shops or pharmacies.

• For most women the dose is 400 micrograms (0.4mg) a day.
• If your risk of having a child with a spinal cord problem is increased then the dose is higher (5mg a day - you need a prescription for this higher dose). That is, if:
  • you have already had a previous baby with a spinal cord problem.
  • you, your partner, or a first-degree relative have a spinal cord problem.
  • you have coeliac disease, diabetes, sickle cell anaemia or thalassaemia.
  • you are taking certain medication for epilepsy (your doctor will advise).