Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. When faced with a patient suffering from this condition, the physician must spend time on history inquiry in order to determine if the individual has risk factors like the use of certain drugs (e.g. methotrexate, sulfonamides, or phenytoin) or suffers from other diseases, such as malabsorption syndromes and chronic hemolytic anemia. Patients address their physician for tongue pain and ulcerations or angular stomatitis, vomiting, anorexia, weight loss, abdominal pain and diarrhea that usually occur after food intake. Hair pigmentation may also change. Neurologic symptoms include depression, impaired abstraction performance [1], a diminished cognitive status that may progress to dementia [2]. Keeping in mind that some studies have shown that folate deficiency may be associated with cervical, esophageal, and colon cancer, as well as ulcerative colitis [3], the physician must inquire about symptoms related to these illnesses, too. Heart disease signs must also be searched for, knowing that low folate intake increases the risk of coronary artery disease [4] [5]. Pregnant women must be closely monitored regarding folate-deficiency anemia signs because folate deficiency is known to cause neural tube birth defects, preterm delivery, growth retardation, and low birth weight [6].

Oral cavity examination frequently reveals a red, swollen, and shiny tongue. Some patients are subfebrile although infection is excluded and present with patchy hyperpigmented areas of the skin and mucous membranes. Their typical location includes dorsal aspects of the toes and fingers, as well as creases of soles and palms.

• Anemia

  Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. [symptoma.com]

  Although several studies have documented the resulting decrease in anemia and folate deficiency, to our knowledge, no one has determined the prevalence of folate-deficiency anemia after fortification. [ncbi.nlm.nih.gov]

  Advertisement Hematology Anemia Folate deficiency anemia Author: R. Amita, M.D., D.N.B. (see Authors page) Revised: 17 September 2018, last major update August 2016 Copyright: (c) 2016-2018, PathologyOutlines.com, Inc. [pathologyoutlines.com]

  Folate deficiency anemia, unspecified D53 Other nutritional anemias D53.0 Protein deficiency anemia D53.1 Other megaloblastic anemias, not elsewhere classified D53.2 Scorbutic anemia D53.8 Other specified nutritional anemias D53.9 Nutritional anemia, [icd10data.com]

  NIH: National Heart, Lung, and Blood Institute Anemia (Medical Encyclopedia) Anemia - B12 deficiency (Medical Encyclopedia) Anemia caused by low iron -- infants and toddlers (Medical Encyclopedia) Anemia of chronic disease (Medical Encyclopedia) Anemia [icdlist.com]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 29, 2019 [patientslikeme.com]

  Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. [symptoma.com]

  Symptoms of folic acid deficiency include: fatigue mouth sores gray hair swollen tongue poor growth (also among the chief symptoms of malnutrition) Once anemia occurs, you might experience the following: fatigue dizziness feeling cold irritability headache [healthline.com]

• Weight Loss

  Patients address their physician for tongue pain and ulcerations or angular stomatitis, vomiting, anorexia, weight loss, abdominal pain and diarrhea that usually occur after food intake. Hair pigmentation may also change. [symptoma.com]

  loss diets Folic acid is needed to help a baby in the womb grow properly. [nlm.nih.gov]

  Other folic acid deficiency symptoms are: Loss of appetite Weight loss Gray hair Depression Diarrhea Poor growth Headache Irritability The primary cause of folic acid deficiency anemia is malnutrition. [gleneaglesglobalhospitals.com]

  People with a folate deficiency will show obvious physical signs like weight loss and loss of appetite. Folate deficiency is also known to cause sore tongue, headache, and irritability. [newsmax.com]

• Pallor

  When to seek medical advice Call your child's healthcare provider right away if any of these occur: Your child refuses to eat or has trouble eating You child has a stomachache, diarrhea, or bloating Symptoms continue or get worse Pallor does not improve [fairview.org]

  For more information see: Folic acid and birth defect prevention Symptoms Fatigue Headache Pallor Sore mouth and tongue Exams and Tests The doctor or nurse will perform a physical exam. [lutheranhealthcare.org]

  Symptoms Symptoms may include: Fatigue Headache Pallor Sore mouth and tongue Exams and Tests The health care provider will perform a physical exam. [ufhealth.org]

  Symptoms may include: Fatigue Weakness Headache Pallor Sore mouth and tongue The goal is to identify and treat the cause of the folate deficiency. [nlm.nih.gov]

• Epilepsy

  In a prospective study of women with epilepsy, folic acid levels decreased with increasing plasma AED levels and with the number of AEDs. [epilepsy.com]

  You are taking certain medication for epilepsy (your doctor will advise). See also the separate leaflets called Planning to Become Pregnant and Diet and Lifestyle during Pregnancy . [patient.info]

  Use of safe drugs, especially drugs that limit the absorption of folic acid such as bacbituric, anticonvulsants, drugs for epilepsy, antimalarial drugs, anti-metabolism drugs, In areas where a high prevalence of anemia is present in pregnant women, supplementation [hellodoktor.com]

  Patients with health risks, including epilepsy, insulin dependent diabetes, obesity with BMI >35 kg/m 2, family history of neural tube defects, belonging to a high-risk ethnic group (e.g., Indian ancestry): increased dietary intake of folate-rich foods [www2.gov.bc.ca]

• Dyspnea

  Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. [symptoma.com]

  Additional common symptoms include aches and pains, muscle weakness, and difficulty breathing (dyspnea). Individuals with megaloblastic anemia may also develop gastrointestinal abnormalities including diarrhea, nausea, and loss of appetite. [rarediseases.org]

• Nausea

  Increased destruction: superoxide can inactivate folate Clinical features Symptoms due to anemia: weakness, fatigue, difficulty concentrating, irritability, headache, palpitations, shortness of breath, cardiac failure Gastrointestinal symptoms: anorexia, nausea [pathologyoutlines.com]

  High folic acid dosage causes: Abdominal cramps Diarrhea Rash Sleep disorders Irritability Confusion Nausea Upset stomach Behavioral changes Seizures Due to anemia, you may have weakness and fatigue. [gleneaglesglobalhospitals.com]

  Nausea from morning sickness, anorexia, and poor dietary habits also contribute to folate deficiency during pregancy. There is an association between folate deficiency during pregnancy and neural tube defects in the developing fetus. [medcentral.org]

  Symptoms of overdose may include: stomach pain, nausea, vomiting, diarrhea. Notes If your doctor has prescribed this medication for you, do not share it with others. [webmd.com]

  Signs & Symptoms Blackheads (black spots the size of a pinhead); Fatigue and weakness; Paleness; Red, sore tongue; Shortness of breath; Nausea, vomiting and diarrhea (rare); Neurologic abnormalities – only in infants. [rxmed.com]

• Loss of Appetite

  Other folic acid deficiency symptoms are: Loss of appetite Weight loss Gray hair Depression Diarrhea Poor growth Headache Irritability The primary cause of folic acid deficiency anemia is malnutrition. [gleneaglesglobalhospitals.com]

  People with a folate deficiency will show obvious physical signs like weight loss and loss of appetite. Folate deficiency is also known to cause sore tongue, headache, and irritability. [newsmax.com]

  Symptoms of Folic Acid Deficiency Anemia Severe fatigue and weakness Paleness (pallor) Shortness of breath Heart palpitations or noticeably rapid heartbeat upon exertion Sore, red, and glazed-looking tongue Loss of appetite leading to weight loss Abdominal [healthcommunities.com]

  loss of appetite difficulty concentrating Factors that increase your likelihood of developing this condition include: eating overcooked foods consuming a vitamin-poor diet heavy alcohol drinking (alcohol interferes with folate absorption) medical conditions [healthline.com]

• Vomiting

  Patients address their physician for tongue pain and ulcerations or angular stomatitis, vomiting, anorexia, weight loss, abdominal pain and diarrhea that usually occur after food intake. Hair pigmentation may also change. [symptoma.com]

  […] destruction: superoxide can inactivate folate Clinical features Symptoms due to anemia: weakness, fatigue, difficulty concentrating, irritability, headache, palpitations, shortness of breath, cardiac failure Gastrointestinal symptoms: anorexia, nausea, vomiting [pathologyoutlines.com]

  Symptoms of overdose may include: stomach pain, nausea, vomiting, diarrhea. Notes If your doctor has prescribed this medication for you, do not share it with others. [webmd.com]

  Signs & Symptoms Blackheads (black spots the size of a pinhead); Fatigue and weakness; Paleness; Red, sore tongue; Shortness of breath; Nausea, vomiting and diarrhea (rare); Neurologic abnormalities – only in infants. [rxmed.com]

  Deficiency Anemia Severe fatigue and weakness Paleness (pallor) Shortness of breath Heart palpitations or noticeably rapid heartbeat upon exertion Sore, red, and glazed-looking tongue Loss of appetite leading to weight loss Abdominal swelling Nausea, vomiting [healthcommunities.com]

• Sore Mouth

  For more information see: Folic acid and birth defect prevention Symptoms Fatigue Headache Pallor Sore mouth and tongue Exams and Tests The doctor or nurse will perform a physical exam. [lutheranhealthcare.org]

  Symptoms Symptoms may include: Fatigue Headache Pallor Sore mouth and tongue Exams and Tests The health care provider will perform a physical exam. [ufhealth.org]

  Symptoms may include: Fatigue Weakness Headache Pallor Sore mouth and tongue The goal is to identify and treat the cause of the folate deficiency. [nlm.nih.gov]

  Symptoms may include: Fatigue Weakness Headache Pallor Sore mouth and tongue Exams and Tests The health care provider will perform a physical exam. [baptistjax.com]

• Headache

  Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. [symptoma.com]

  Folate deficiency is also known to cause sore tongue, headache, and irritability. [newsmax.com]

  […] alcoholism (increased excretion of folate into bile), hemodialysis (may have excess folate loss) Increased destruction: superoxide can inactivate folate Clinical features Symptoms due to anemia: weakness, fatigue, difficulty concentrating, irritability, headache [pathologyoutlines.com]

  The most common symptoms indicating a folate deficiency are fatigue, headaches, pale skin and a painful tongue. [soscuisine.com]

  You may be short of breath or have a headache. Your doctor will diagnose anemia with a physical exam and blood tests. Treatment depends on the kind of anemia you have. [icdlist.com]

• Irritability

  High folic acid dosage causes: Abdominal cramps Diarrhea Rash Sleep disorders Irritability Confusion Nausea Upset stomach Behavioral changes Seizures Due to anemia, you may have weakness and fatigue. [gleneaglesglobalhospitals.com]

  Folate-deficiency anemia causes symptoms that are common for all types of anemia, like fatigue, irritability, headaches, diminished concentration ability, dyspnea, and palpitations, but also has certain supplementary features. [symptoma.com]

  chronic alcoholism (increased excretion of folate into bile), hemodialysis (may have excess folate loss) Increased destruction: superoxide can inactivate folate Clinical features Symptoms due to anemia: weakness, fatigue, difficulty concentrating, irritability [pathologyoutlines.com]

  […] iron, folic acid or vitamin B12 Blood disorders such as sickle cell anemia and thalassemia, or cancer Aplastic anemia, a condition that can be inherited or acquired G6PD deficiency, a metabolic disorder Anemia can make you feel tired, cold, dizzy, and irritable [icdlist.com]

• Peripheral Neuropathy

  neuropathy, and memory loss). [icid.salisbury.nhs.uk]

  Neurological symptoms (eg, paraesthesia, numbness, cognitive changes, visual disturbance) are more typical of vitamin B12 deficiency but patients with folate deficiency may report mild symptoms of peripheral neuropathy or psychiatric disturbance (eg, [patient.info]

  Nerve pain (peripheral neuropathy). There is conflicting evidence about the role of folic acid in nerve pain for people with diabetes ( diabetic neuropathy ). [emedicinehealth.com]

  neuropathy ), particularly in the legs If neurological problems do develop, they may be irreversible. [nhsinform.scot]

• Paresthesia

  Patients with vitamin B 12 deficiency may describe paresthesias related to peripheral neuropathy, poor or strict vegan diet, lack of socioeconomic resources, bowel-related symptoms (including diarrhea), or a history of bowel surgery for weight loss. [aafp.org]

  The more common neurologic symptoms are paresthesias, numbness, and ataxia, although dementia and psychosis may occur. 7 Although hematologic abnormalities frequently develop before the onset of neurologic disease, more than one quarter of patients with [jamanetwork.com]

Blood workup should include a complete blood count, demonstrating the presence of megaloblastic anemia. The mean corpuscular volume is typically increased (above 96 fL ). A blood smear will show macrocytes, hypersegmented polymorphs, leukopenia, and thrombocytopenia if the deficiency is severe enough. In extreme cases, pancytopenia can be observed. The next step is to demonstrate folate deficiency and that is achieved by measuring folate levels. Cobalamin serum levels should also be measured in order to exclude cobalamin deficiency. Blood homocysteine will be found increased, above the reference range of 5-16 mmol/L, but it can be influenced by other factors, like kidney disease [7]. Folate levels can also be measured in the red blood cells by radioisotope dilution, but this value is considered to be less reliable because it offers information about the folate status over the lifetime of the erythrocytes, whereas short term folate status is reflected by its serum level [8]. A bone marrow biopsy will demonstrate megaloblastic cell maturation. Liver function tests and thyroid function tests are useful in cases where undeclared alcohol abuse or hypothyroidism are suspected, respectively. Malabsorptive disorders, if suspected, should be thoroughly searched for.

• Macrocytosis

  However, this concept remains useful for identifying the most predominant etiology for macrocytosis. [aafp.org]

  […] and Macrocytic Anaemia Source: Patient Macrocytosis means that the red blood cells are larger than normal. [evidence.nhs.uk]

  […] with anaemia but those patients who have macrocytosis with anaemia should have vitamin B12 and folate measurements performed. 2.2.2 Macrocytosis The level of macrocytosis can predict the probability of vitamin B12 and folate deficiency being present. [icid.salisbury.nhs.uk]

  Both subjects were African American women with markedly elevated C-reactive protein concentrations, macrocytosis, and normal serum cobalamin concentrations; only one subject was anemic. [ncbi.nlm.nih.gov]

• Macrocytic Anemia

  Folate deficiency is one of the causes of macrocytic anemia. [epilepsy.com]

  Definition / general Folate deficiency is a low level of folic acid (Vitamin B9) in the body Essential features Characterized by macrocytic anemia Terminology Also called Vitamin B9 deficiency Pathophysiology Etiology Inadequate ingestion of folate containing [pathologyoutlines.com]

  Once a macrocytic anemia is identified (MCV >100) and medications excluded, a PBS should be examined. Round macrocytes suggest possible thyroid or liver disease, while oval macrocytes suggest B12 or folate deficiency. [med-ed.virginia.edu]

  Algorithm for the evaluation of macrocytic anemia. (RBC = red blood cell; MMA = methylmalonic acid.) Evaluation of Macrocytic Anemia Figure 3. Algorithm for the evaluation of macrocytic anemia. (RBC = red blood cell; MMA = methylmalonic acid.) [aafp.org]

• Leukopenia

  A blood smear will show macrocytes, hypersegmented polymorphs, leukopenia, and thrombocytopenia if the deficiency is severe enough. In extreme cases, pancytopenia can be observed. [symptoma.com]

  The disease also is characterized by leukopenia (a deficiency of white blood cells, or leukocytes ), by thrombocytopenia (a deficiency of platelets ), by ineffective blood formation in the bone marrow, and by progressive gastrointestinal symptoms, such [britannica.com]

  If severe, there may be leukopenia and thrombocytopenia. There is no clear consensus on the level of serum folate that indicates deficiency. [patient.info]

• Neutropenia

  The following tests should be ordered: Complete blood count (CBC): Diagnosis of folate deficiency should be considered in the presence of anemia, macrocytosis (MCV > 100 fL with ovalocytosis, possibly in conjunction with thrombocytopenia and neutropenia [clinicaladvisor.com]

  Less commonly, neutropenia and thrombocytopenia also will occur, although it usually will not be as severe as the anemia. In rare cases, the absolute neutrophil count can drop below 1000/mL and the platelet count below 50,000/mL. [emedicine.medscape.com]

• Folic Acid Decreased

  Recent studies found that supplemental vitamin B12 and folic acid decreased homocysteine levels in subjects with vascular disease and in young adult women. The most significant drop in homocysteine level was seen when folic acid was taken alone. [moyak.com]

• Megaloblastic Bone Marrow

  Anemia, Megaloblastic Synonyms of Anemia, Megaloblastic Folate Deficiency Anemia Folic Acid Deficiency Anemia Vitamin B12 Deficiency Anemia General Discussion Megaloblastic anemia is a condition in which the bone marrow produces unusually large, structurally [rarediseases.org]

  Defective DNA synthesis in human megaloblastic bone marrow: effects of homocysteine and methionine. J Clin Invest. 1969;48(2):284–289. 15. Ortiz Z, Shea B, Suarez Almazor M, Moher D, Wells G, Tugwell P. [aafp.org]

Treatment Giving patients 5mg / day of folic acid can also ensure the restoration of reserves. In fact, treatment with folic acid is not dangerous because there is no risk of cumulative factors. [hellodoktor.com]

or therapies expectations for the course of the disease your opinion or preference Treatment may include: vitamin and mineral supplements change in diet medication treatment of the causative disease Treatment usually involves taking an oral or injected [medcentral.org]

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you. [hopkinsmedicine.org]

Early treatment is needed to prevent problems such as poor reasoning and learning. [elcaminohospital.org]

Outlook (Prognosis) Anemia usually responds well to treatment within 2 months. Possible Complications Symptoms of anemia can cause discomfort. [lutheranhealthcare.org]

Outlook (Prognosis) Anemia most often responds well to treatment within 2 months. Possible Complications Symptoms of anemia can cause discomfort. [ufhealth.org]

Outlook (Prognosis) Folate-deficiency anemia most often responds well to treatment within 3 to 6 months. It will likely get better when the underlying cause of the deficiency is treated. [baptistjax.com]

Outlook (Prognosis) Most people with hereditary elliptocytosis have no problems. They often do not know they have the condition. Possible Complications Elliptocytosis is often harmless. [mclarenhealthplan.org]

Prognosis Usually reversible in three to four weeks with an adequate folic acid intake. [rxmed.com]

Definition / general Folate deficiency is a low level of folic acid (Vitamin B9) in the body Essential features Characterized by macrocytic anemia Terminology Also called Vitamin B9 deficiency Pathophysiology Etiology Inadequate ingestion of folate containing [pathologyoutlines.com]

The most common etiologies are alcoholism, vitamin B 12 and folate deficiencies, and medications. [aafp.org]

Etiology The most common causes of folate deficiency are Inadequate intake (usually in patients with undernutrition or alcoholism) Increased demand (eg, due to pregnancy or lactation) Deficiency can also result from inadequate bioavailability and increased [merckmanuals.com]

Article navigation 1From the Department of Epidemiology (OAO, RSW, DAA, and GPO) and Center for Spina Bifida Research, Prevention and Policy (GPO), Rollins School of Public Health, Emory University, Atlanta, GA; the Departments of Medicine and Oncology [ajcn.nutrition.org]

[…] supplementation and child Asperger syndrome or pervasive developmental disorder-not otherwise specified. [6] Effects on carcinogens Diminished folate status has historically been associated with enhanced carcinogenesis. [16] As recently as 2002, authors cited epidemiologic [emedicine.medscape.com]

Epidemiologic evidence generally indicates that a high intake of folate-rich foods offers protection against the development of some common cancers, but the relationship between folic acid and cancer is complicated, as you’ve learned. [draxe.com]

Definition / general Folate deficiency is a low level of folic acid (Vitamin B9) in the body Essential features Characterized by macrocytic anemia Terminology Also called Vitamin B9 deficiency Pathophysiology Etiology Inadequate ingestion of folate containing [pathologyoutlines.com]

A temperature chart documenting the course of the patient's pyrexia is presented and potential pathophysiological mechanisms are proposed. [casesjournal.biomedcentral.com]

Understanding Pathophysiology (3rd ed.). Mosby. p. 543. ISBN 978-0-323-02368-9. ^ Tamparo C (2011). Diseases of the Human Body (Fifth ed.). Philadelphia, PA. p. 337. ISBN 978-0-8036-2505-1. ^ Haslam N, Probert CS (February 1998). [en.wikipedia.org]

Alcohol 26 65 15 36 B 12 and/or folate deficiency 6 9 28 21 Medications 37* 3 2 11 Hypothyroidism — 1 12 5 Bone marrow dysplasias 6 1 5 5 Liver disease (nonalcoholic) 6 — 2 6 Reticulocytosis 8 — — 7 Miscellaneous 3 21 13 7 Not established 7 — 22 12 Pathophysiology [aafp.org]

Taking 300-400 mcg of folic acid daily is commonly used during pregnancy to prevent birth defects. [emedicinehealth.com]

A few of them are mentioned below: Preventing and treating low blood levels Used for memory loss Use to prevent heart disease Prevent miscarriage and birth defects Prevent hearing loss Prevents depression Treats anemia Used for kidney diseases Used in [gleneaglesglobalhospitals.com]

Prevention The prevention of folic acid is primarily through nutrition. It is important to know the use of appropriate food sources, especially green vegetables as well as other ingredients. [hellodoktor.com]

Prevention Eating plenty of folate-rich foods can help prevent this condition. Experts recommend that women take 400 micrograms (mcg) of folic acid every day before they get pregnant and through the first 3 months of their pregnancy. [lutheranhealthcare.org]

Preventive Services Task Force (2009). Folic acid to prevent neural tube defects. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsnrfol.htm. Credits By Healthwise Staff Primary Medical Reviewer E. [northshore.org]

1. La Rue A, Koehler K, Wayne S, et al. Nutritional status and cognitive functioning in a normally aging sample: a 6-y reassessment. Am J Clin Nutr. 1997;65:20–29.
2. Stokstad EL, Chan MM, Watson JE, et al. Nutritional interactions of vitamin B12, folic acid, and thyroxine. Ann N Y Acad Sci. 1980;355:119-129.
3. Lashner B, Provencer K, Seidner D, et al. The Effect of Folic Acid Supplementation on the Risk for Cancer or Dysplasia in Ulcerative Colitis. Gastroenterology. 1997;112:29–32.
4. Landgren F, Israelsson B, Lindgren A, et al. Plasma homocysteine in acute myocardial infarction: homocysteine-lowering effect of folic acid. J Intern Med. 1995;237:381–388.
5. Morrison H I, Schaubel D, Desmeules M, et al. J Am Med Assoc. Serum folate and risk of fatal coronary heart disease. 1996;275:1893–1896.
6. Scholl TO, Johnson WG. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr. 2000; 71(5): 1295S-303S.
7. Green R. Indicators for assessing folate and vitamin B-12 status and for monitoring the efficacy of intervention strategies. Am J Clin Nutr. 2011; 94(2): 666S-672S.
8. Yetley EA, Pfeiffer CM, Phinney KW, et al. Biomarkers of folate status in NHANES: a roundtable summary. Am J Clin Nutr. 2011;94(1): 303S-312S.