II. Epidemiology

  1. Rare in the United States due to fortified cereals

III. Causes

  1. Inadequate Folate intake
    1. Alcohol Abuse
    2. Elderly
    3. Vegan Diet
  2. Increased Folate utilization
    1. Pregnancy
    2. Malignancy
  3. Medications
    1. See Medications Affecting Folate Metabolism

IV. Labs

  1. Complete Blood Count
    1. See Hemoglobin Cutoffs for Anemia
    2. See Hematocrit Cutoffs for Anemia
    3. Macrocytic Anemia (Mean Corpuscular Volume >100 um^3)
      1. MCV cutoff varies by age and per reference
  2. RBC Folate decreased
    1. Not the same as Serum Folate, which fluctuates considerably with diet
  3. Serum Vitamin B12 normal

V. Management

  1. Do not initiate Folate until B12 Deficiency ruled-out
    1. Folate supplementation masks B12 Deficiency
    2. Neurologic B12 Deficiency sequelae will progress
  2. Folic Acid 1 mg orally daily for 3 weeks or until resolved

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Ontology: Folic Acid Deficiency (C0016412)

Definition (MSH) A nutritional condition produced by a deficiency of FOLIC ACID in the diet. Many plant and animal tissues contain folic acid, abundant in green leafy vegetables, yeast, liver, and mushrooms but destroyed by long-term cooking. Alcohol interferes with its intermediate metabolism and absorption. Folic acid deficiency may develop in long-term anticonvulsant therapy or with use of oral contraceptives. This deficiency causes anemia, macrocytic anemia, and megaloblastic anemia. It is indistinguishable from vitamin B 12 deficiency in peripheral blood and bone marrow findings, but the neurologic lesions seen in B 12 deficiency do not occur. (Merck Manual, 16th ed)
Definition (CSP) state in which folate is absent or in diminished amount relative to the normal requirement of an organism or a biologic system.
Concepts Disease or Syndrome (T047)
MSH D005494
ICD10 E53.8
SnomedCT 124913008, 190633005
English Acid Deficiencies, Folic, Acid Deficiency, Folic, Deficiencies, Folic Acid, Deficiency, Folic Acid, Folic Acid Deficiencies, Folic Acid Deficiency, DEFIC FOLIC ACID, FOLIC ACID DEFIC, folic acid deficiency, folic acid deficiency (diagnosis), Folic Acid Deficiency [Disease/Finding], Deficiency;vitamin;folate, acid folic deficiency, acid deficiency folic, deficiency folate, Deficiency of folic acid (disorder), Folic acid deficiency, Folate deficiency, Folic acid deficiency (disorder), deficiency; folate, deficiency; folic acid, folate; deficiency, folic acid; deficiency, Deficiency of folic acid, folate deficiency
Italian Carenza di folato, Carenza di acido folico
Dutch folinezuurdeficiëntie, deficiëntie; folaat, deficiëntie; foliumzuur, folaat; deficiëntie, foliumzuur; deficiëntie, folaatdeficiëntie, Folinezuurgebrek, Deficiëntie, folinezuur-, Folinezuurdeficiëntie
German Folsaeuremangel, Folatmangel, Folsäuremangel
Spanish Déficit de ácido fólico, déficit de ácido fólico (trastorno), deficiencia de folato, deficiencia de ácido fólico (trastorno), deficiencia de ácido fólico, Déficit de folato, Deficiencia de Ácido Fólico
Swedish Folsyrabrist
Japanese ヨウサンケツボウ, ビタミンM欠乏症, 葉酸欠乏症, 葉酸欠乏
Finnish Foolihapon puutos
Russian FOLIEVOI KISLOTY NEDOSTATOCHNOST', ФОЛИЕВОЙ КИСЛОТЫ НЕДОСТАТОЧНОСТЬ
Czech Deficit folátu, Deficit kyseliny listové, kyselina listová - nedostatek, nedostatek kyseliny listové, deficit kyseliny listové
Polish Niedobór kwasu foliowego
Hungarian Folat hiány, Folsav hiány
Norwegian Folsyremangel, Folatmangel, Folinsyremangel
Portuguese Carência de ácido fólico, Deficiência de Ácido Fólico
French Carence en folates, Carence en acide folique, Carence en vit B9, Carence en vitamine B9, Déficit en acide folique, Déficit en vitamine B9