Folic Acid Deficiency Anemia

Question 1

Folic Acid

Answer 1

• heat-labile vitamin necessary for production of DNA and RNA
• humans depend on dietary source

Question 2

Major Causes of FADA

Answer 2

• inadequate intake
• decreased absorption
• hyperutilization
• inadequate utilization

Question 3

What medications may affect folic acid levels?

Answer 3

• chemo agents or AI meds: 6-mercaptopurine, 5-fluorouracil, hydroxyurea
• folate antagonists: methotrexate, trimethoprim
• also phenytoin, phenobarbital

Question 4

Signs and Sxs of FADA

Answer 4

-usually insidious onset
-glossitis
-dysphagia
-anorexia
(similar to B12 without the neuro sxs)

Question 5

Lab Findings of FADA

Answer 5

• MCV > 100
• mild leukopenia and thrombocytopenia
• low retic, hct, serum and RBC folate

Question 6

Treatment of FADA

Answer 6

-1-5 mg PO qday x4 months (most just need 1 mg)

Question 7

In order to avoid discontinuation of AED meds, what can be done for folate therapy?

Answer 7

-low dose folate 500 mcg PO qday

Question 8

Why is folic acid used in pregnancy? How much should be used?

Answer 8

• 400-1000 mcg/day prior to conception and during pregnancy

- reduces incidence of neural tube defects

Question 9

Monitoring of FADA

Answer 9

• symptomatic improvement early
• reticulocytosis in 2-3 days, peaks 1 week
• hct begins to rise in 2 weeks, normal in 2 months
• MCV initially increases, then goes back to normal