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Folate-deficiency anaemia

Folate, one of the B-group of vitamins, is needed for many important processes inside your body, including making red blood cells. If you have less folate than you need, your body won't make as many red blood cells, and the red blood cells that are produced will be abnormally large in size and won't last as long as they should.

Anaemia occurs when there are too few red blood cells or not enough haemoglobin in the blood. Folate-deficiency anaemia is a type of anaemia that’s caused when there isn't enough folate in the body.


Symptoms of folate-deficiency anaemia

If you don't have enough red blood cells, the tissues and organs of your body may not be getting enough oxygen. This leads to the symptoms of anaemia.

The symptoms of folate-deficiency anaemia include:

  • tiredness
  • breathlessness, even after a little exercise
  • heart palpitations(the sensation of feeling your heart thumping in your chest)
  • depression or other emotional changes.

These symptoms aren't always due to folate-deficiency anaemia but if you have them it’s a good idea to see your GP.

If folate-deficiency anaemia isn't treated, a range of possible complications can result. For example, it may increase your risk of heart problems and certain cancers. Talk to your GP for more information.


Causes of folate-deficiency anaemia

Eating a diet that is low in folate is the most common cause of folate-deficiency anaemia. This is because your body can't store folate for long periods of time and you need to eat foods that contain folate every day to make sure your body has enough.

Other causes of folate-deficiency anaemia include the following:

  • Blood conditions. Conditions that cause a faster turnover of red blood cells such as thalassaemia (a genetic disorder in which haemoglobin isn't correctly formed) and haemolytic anaemia (in which red blood cells are fragile and easily damaged in the bloodstream).
  • Alcohol. Drinking too much alcohol can reduce your body's ability to use folate.
  • Digestive disorders. This includes coeliac disease or inflammatory bowel disease (such as Crohn's disease) which can reduce your body’s ability to absorb folate.
  • Certain medicines. For example, some medicines used to treat epilepsy and rheumatoid arthritis which interfere with folate levels.
  • Pregnancy. A pregnant woman needs extra folate to meet the needs of her growing baby and to prevent a range of conditions called neural tube defects where the baby’s neural tube (the developing central nervous system) fails to completely close over the spinal cord.

Diagnosing folate-deficiency anaemia

Your GP will ask about your symptoms, examine you and they may also ask you about your medical history.

You will be asked to have a blood test where a sample of your blood is sent to a laboratory for testing. This will include a full blood count (FBC) that shows the level of haemoglobin in your blood and how many of each of the different types of blood cell you have. A FBC test will also show the size of your red cells and the amount of haemoglobin each one contains.

The normal haemoglobin level range for adults is at least 130g/L – 185g/L for men and 115g/L – 165g/L for women. Haemoglobin levels drop slightly during normal pregnancy so a normal concentration of haemoglobin in pregnant women is around 110g/L.

If your haemoglobin level is lower, you may have folate-deficiency anaemia. Your doctor will also look at the size of your red blood cells as folate deficiency can cause them to be enlarged. If they are enlarged you may have a condition called macrocytic anaemia.

The level of folate in your blood can also be measured with the blood test. Your level of vitamin B12 will be checked too, because it's possible to have deficiencies of both vitamins at the same time.

Your GP may then refer you to a haematologist (a doctor who specialises in treating blood disorders) to have further tests.


Treating folate-deficiency anaemia

Your doctor will try to identify why you're deficient in folate so that the cause can be treated. If you don't get enough folate in your diet, your doctor may give you advice on how to improve your diet, or refer you to an accredited practising dietitian.

You may be advised to take folate in the form of tablets. Folate comes in a synthetic (artificial) form called folic acid. This is a water-soluble vitamin that your body can use instead of folate. To treat folate-deficiency anaemia, you will probably need to take 5mg per day for a few months. Always read the accompanying consumer medicine information leaflet and ask your pharmacist or GP for advice if you have any questions.

Before starting treatment, your doctor will check your vitamin B12 levels. This is because taking folate/folic acid can hide a vitamin B12 deficiency which can cause another type of anaemia called pernicious anaemia. For more information about vitamin B12-deficiency anaemia click here.

If you're taking folate tablets, your GP will monitor your blood to check that they are working. You will be asked to have a blood test shortly after starting treatment, and again about eight weeks later to confirm that your treatment is working.

Most people need to take folic acid for only four months before they see an improvement in their symptoms. However, some people need to take folic acid for longer periods, and sometimes for life, if the cause of the deficiency isn't resolved.

Folic acid and pregnancy

If you're pregnant and don't get enough folate in your diet, there is an increased risk of neural tube defects in your developing baby. A neural tube defect is when your unborn baby's nerves and spinal cord don't develop properly in the first month of pregnancy. It can result in spina bifida, where the bones of your baby's spine don't completely enclose the spinal cord.

To reduce your risk of this, plan ahead and start taking a supplement of at least 0.4mg (400 micrograms) of folic acid before you become pregnant and for the first 12 weeks (the first trimester) of pregnancy. If you're at a high risk of having a baby with a neural tube defect, your doctor will prescribe a much higher dose of 5000 micrograms (5mg) folic acid daily. Folic acid is available at your local pharmacy and you can talk to your pharmacist for more advice.

Folate-containing foods

It's also important to eat folate-rich foods. The term folate comes from the Latin word for leaf (folium) so you won’t be surprised to learn that leafy vegetables are a good source of this vitamin. Other good sources are broccoli, Brussels sprouts, asparagus, peas, chickpeas, brown rice, unsalted peanuts and walnuts. Although liver is a good source of folate, pregnant women shouldn't eat more than 50g of liver per week as it is very rich in vitamin A. Large intakes of vitamin A during pregnancy are linked with an increased risk of birth defects.

Since September 2009, most breads (excluding organic bread) have been made with flour fortified with folic acid, which means that folic acid has been added during manufacturing. Fortification was made mandatory to try and help ensure that everyone gets enough folate in their diet. In Australia, many breakfast cereals and margarines are fortified with folic acid, too.


Prevention of folate-deficiency anaemia

The best way to prevent folate-deficiency anaemia is to eat a balanced diet containing plenty of folate. The recommended amount for adults is 0.2mg (200 micrograms) per day. A healthy diet that includes vegetables, fruit and grains should contain this much – another good reason to aim for two fruit serves and five serves of veggies every day.

Folate is damaged by heat, so fruit and vegetables contain more folate when you eat them raw or lightly cooked. Also try microwaving vegetables in just a small amount of water or steam them to retain more of this delicate vitamin.


Further Information

Dietitians Association of Australia

Food Standards Australia New Zealand



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Last published: 31 October 2011

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