Folate deficiency

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Folate deficiency
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Folic acid (B9)
ICD-10	D52 E53.8
ICD-9	266.2
DiseasesDB	4894
MedlinePlus	000354
MeSH	D005494

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Overview

• Folic acid is necessary for the normal production of red blood cells
• Folic acid is part of the vitamin B complex

Reference Range
Folic Acid in Serum/Plasma Deficiency	3.6-15 mg/dl
Adequate Folic Acid Supply	> 4 ug/l
Erythrocyte Folic Acid	120-800 ug/l

Signs of folic acid deficiency are often subtle.

Presentation

Diarrhea, loss of appetite, and weight loss can occur. Additional signs are weakness, sore tongue, headaches, heart palpitations, irritability, and behavioral disorders.

Women with folate deficiency who become pregnant are more likely to give birth to low birth weight and premature infants, and infants with neural tube defects.

In adults, anemia (Macrocytic, Megaloblastic anemia) is a sign of advanced folate deficiency.

In infants and children, folate deficiency can slow growth rate.

Late studies suggested an involvement in tumorogenesis (especially in colon) through demethylation/hypomethylation of fast replicating tissues.

Some of these symptoms can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

Differential Diagnosis of Causes of Folate deficiency

A deficiency of folate can occur when your need for folate is increased, when dietary intake of folate is inadequate, and when your body excretes (or loses) more folate than usual. Medications that interfere with your body's ability to use folate may also increase the need for this vitamin. Some research indicates that exposure to ultraviolet light, including the use of tanning beds, can lead to a folic acid deficiency. [3] The evolution of human skin color is partly controlled by the need to have dark skin in the tropics to protect folic acid from ultraviolet light.

Situational

Some situations that increase the need for folate include:

• pregnancy and lactation (breastfeeding)
• Alcoholism
• Tobacco smoking
• malabsorption, including celiac disease
• kidney dialysis
• liver disease
• certain anemias.

Medicational

Medications can interfere with folate utilization, including:

• anticonvulsant medications (such as phenytoin, and primidone)
• metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
• sulfasalazine (used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis)
• triamterene (a diuretic)
• methotrexate, an anti-cancer drug also used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis.

Inadequate Folate Intake

• Advanced age
• Alcohol abuse
• Celiac Disease
• Crohn's Disease
• Malabsorption
• Malnutrition
• Postoperative
• Ulcerateive colitis
• Vegetarians

Increased Folate Utilization

• Childhood
• Chronic blood loss
• Chronic hemolytic anemia
• Hyperthyroidism
• Lactation
• Leukemias
• Macrocytic anemia
• Other anemias
• Pregnancy
• Psoriasis
• Solid tumors

Other

• Congenital impairment of folic acid metabolism
• Drugs
• Enzyme defects
• Hematologic diseases

Treatment

Folic acid supplements are normally given with sulfasalazine. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. It may therefore be counter-productive to take a folic acid supplement with methotrexate. Although the folic acid inhibition of sulfasalazine is normally seen as a side effect, it is possible that it is a part of the therapeutic effect of the drug, given that methotrexate, a frank folic acid inhibitor, is often given if sulfasalazine fails. It would therefore be wise to consult with a physician before taking a folic acid supplement along with sulfasalazine or methotrexate.

References

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