Folate Deficiency Anemia

1. Etiology

1.1. Folate is a necessary vitamin for DNA/RNA synthesis (synthesizes thymine and purines)

1.1.1. conversion of homocysteine to methionine

1.2. dietary intake needs total of 50-200mcg/day

1.2.1. Increased amount for pregnant and breastfeeding females

1.3. Absorbed in small intestine

1.3.1. circulates and then stored in liver

1.4. Anemia results from apoptosis of erythroblasts in late stage

2. Risk Factors

2.1. Chronic malnourishment

2.2. Alcoholism

2.2.1. ETOH interferes with folate metabolism and decreases stores in the liver

2.3. low vegetable intake

2.3.1. plants are good sources of folate

2.4. pregnancy

2.4.1. Can cause neural tube defect with deficiency in folate

2.5. CAD

2.5.1. Folate reduces circulating levels of homocysteine which can increase risk for atherosclerosis development

2.6. Is associated with colorectal cancers

2.7. Undiagnosed inflammatory bowel syndrome might lead to folate malabsorption

2.7.1. the deficiency can suppress proliferation of intestinal mucosa= more GI damage

3. diagnostic tools

3.1. under microscope: megaloblastic cells w/clumped nuclear chromatin

3.2. Serum folate levels

3.3. clinical signs and symptoms

4. Treatments

4.1. daily folate 1mg PO until reduction of symptoms and normal folate levels appear

4.1.1. usually 1-2 weeks

4.2. 5mg PO/day for alcoholic persons

4.3. 0.1-0.4mg PO/day prophylactic for pregnancy

4.4. 400mcg/day recommended to prevent heart disease

5. Clinical Manifestations

5.1. Cheilosis

5.1.1. scales/fissures at corner of mouth

5.2. Stomatitis

5.3. Burning Mouth Syndrome

5.3.1. Buccal mucosa and tongue ulcers

5.4. GI symtoms

5.4.1. dysphagia

5.4.2. flatulence

5.4.3. watery diarrhea

5.5. neuro damage from other deficiencies associated but not a direct cause