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    Folate-deficiency Anaemia

    Folate-deficiency anaemia

    This factsheet is for people who have anaemia caused by a lack of folate (or folic acid), or who would like information about it.

    Anaemia is a condition where you have too few red blood cells or not enough haemoglobin in your blood. It can make you feel tired, breathless and faint.

    * About folate-deficiency anaemia
    * Symptoms
    * Causes
    * Diagnosis
    * Treatment
    * Prevention
    * Folate and pregnancy
    * Further information
    * Sources
    * Related topics

    About folate-deficiency anaemia

    In adults, blood cells are made by red bone marrow, which is found inside the centre of the hips, ribs, breastbone and backbone, plus the ends of long bones such as the thigh. Red blood cells live for around 120 days before they are broken down and replaced, as part of a normal renewal process.

    You need folate (also called folic acid) for the production of your red blood cells. A lack of folate can cause you to develop anaemia. You also need other nutrients for your body to make red blood cells, including iron and vitamin B12.
    Symptoms

    People with folate-deficiency anaemia have symptoms caused by a low level of oxygen-carrying red blood cells in the body. These include:

    * breathlessness
    * tiredness
    * dizziness
    * rapid, weak pulse rate
    * palpitations
    * headaches
    * paleness (of skin and inside eyelids)

    Causes

    There are many different types of anaemia. Folate deficiency (shortage) is just one possible cause.

    Folate is needed to make red blood cells because it's a crucial ingredient in DNA, the chemical that carries genetic information for all new cells. Without enough folate, the body can't make or maintain new cells.

    * The most common cause of folate deficiency is a poor diet. This can be due to simply not eating enough, as with anorexia nervosa or poverty, or because the diet has very limited variety. This can be a problem for the elderly, teenagers and people with drug and alcohol problems. Fad diets, where food choice is limited, can also lack sufficient folate.
    * Certain medicines, such as some anti-epileptics and the drug methotrexate used for rheumatoid arthritis, can interfere with folate levels.
    * Excess alcohol intake can impair the body's ability to use folate.
    * During pregnancy, women require extra folate to meet the needs of the baby. Women who are trying to conceive or are pregnant are advised to take a daily 400 microgram folate supplement.
    * Certain conditions that affect the gut can cause poor absorption of folate, for example coeliac disease and Crohn's disease.
    * Faster turnover of red blood cells can happen with certain blood conditions. These include thalassaemia, a genetic disorder in which haemoglobin is not correctly formed, and haemolytic anaemia, in which red blood cells are fragile and easily damaged in the bloodstream.

    Diagnosis

    If you have symptoms of anaemia, such as pale skin, weakness and fatigue, you should visit your GP. He or she will ask about your symptoms, medical history and current eating habits, and perform a physical examination.

    If your doctor suspects you have folate-deficiency anaemia, he or she will probably ask you to have a blood test called a full blood count (FBC).

    The normal amount - or concentration - of haemoglobin for men is at least 13.5g/dl (13.5 grams of haemoglobin per decilitre of blood - a decilitre is 100ml) and 11.5g/dl for women. Levels lower than this indicate anaemia.

    The size of the red blood cells will also be examined. Enlarged red cells are caused by folate (and/or vitamin B12) deficiency. If they are found in the test, the condition is called macrocytic anaemia. Finding enlarged red cells in the blood can help to diagnose anaemia but does not prove the cause. Levels of folate can be measured with a blood test. Levels of B12 would also be checked because it's possible to have deficiencies of both nutrients at the same time.

    Sometimes the cause of folate-deficiency anaemia is clear, for example, poor diet or the medicines you are on. If the cause isn't clear, your GP may recommend further tests. These may include a blood test for coeliac disease - a condition that causes poor absorption of nutrients like folate, or blood problems, such as thalassaemia.
    Treatment

    Folate deficiency is treated by taking daily folate tablets. The folate comes in the form of the synthetic (man-made) form called folic acid. This is a water-soluble vitamin that the body can use instead of folate. The normal dose is 5mg per day for four months. Before starting treatment, your doctor will probably also check your vitamin B12 levels. This is because taking high doses of folic acid can hide a vitamin B12 deficiency. If your doctor diagnoses an underlying cause for your folate deficiency, this will also need to be treated.
    Prevention

    The best way to prevent folate-deficiency anaemia is to eat a balanced, varied diet containing plenty of folate. The recommended daily amount for adults is 200 micrograms per day. A normal diet that includes vegetables, fruit and grains contains about 200 to 300 micrograms.

    Folate is found in small amounts in leafy green vegetables like spinach, watercress and curly kale, some fruits (especially oranges and satsumas), brewers yeast, liver and breads or breakfast cereals that have been fortified with vitamins. Fortified means that folic acid has been added during manufacturing.

    The following is a list of the amount of folate contained in a typical portion of these foods:

    * spinach (boiled) - 73 micrograms
    * yeast extract on once slice of toast (eg Marmite) - 26 micrograms
    * oranges (medium sized) - 50 micrograms
    * fortified breakfast cereal - 50 to 100 micrograms
    * granary bread - 32 micrograms
    * chicken liver (fried) - 945 micrograms

    Folate is damaged by heat so fruit and vegetables contain more folate when raw than when they are cooked.
    Folate and pregnancy

    Pregnant women who don't get enough folate in their diet have an increased risk of neural tube defects in their developing baby. Neural tube defects are where the nerves and spinal cord don't develop properly in the first month of pregnancy. It can result in spina bifida, where the bones of the spine don't completely enclose the spinal cord. If you are planning to have a baby, taking a supplement of 400 micrograms of folic acid before you conceive and in the first 12 weeks of pregnancy helps to reduce the risk of a neural tube defect.

    If you are pregnant, you should also try to include folate-rich foods (see Prevention). However, pregnant women should not eat liver or liver pâté because of liver's high vitamin A content. Large intakes of vitamin A during pregnancy are linked with an increased risk of birth defects.

    In some countries, including the US, all flour has to be fortified with folate to help ensure everyone gets enough folate in their diet. In the UK many breakfast cereals and margarines are fortified.

  2. #2
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    Re: Folate-deficiency Anaemia

    I'm actually diagnosed by our company doctor as anemic, although, he did not give me the specific type of anemia listed above. my fbc is way lower than normal, she advised to be take 500mg ferrous sulfate for the next 6 months. i'm religiously following the advise as well as making sure to eat folate rich foods.

 

 

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