Folic Acid Deficiency Anemia

Folic acid, a type of B vitamin, plays a critical role in our bodies, particularly in the synthesis of red blood cells. A deficiency in this essential nutrient can lead to anemia, a condition characterized by a lack of healthy red blood cells to carry oxygen to the body's tissues.

What is Folic Acid?

Folic acid, also known as folates, is a water-soluble vitamin. Its biologically active form is tetrahydrofolic acid (THF). It is predominantly found in certain foods of plant origin, such as beans, tomatoes, and oranges, as well as in offal. However, it's worth noting that folic acid is thermolabile, meaning it can be easily destroyed by heat.

The primary metabolic function of folic acid is to generate coenzymes that aid in the transport of single carbon units in amino acid metabolism and nucleic acid synthesis. It works biochemically with cobalamin, another B vitamin, to participate in the production of nucleic acids (DNA and RNA), transform homocysteine into methionine, and metabolize other amino acids.

The reduction in folic acid's metabolic activity can lead to various imbalances, including a decrease in DNA and RNA synthesis. This can result in a diminished ability to replace old or damaged cells with new ones, leading to serious functional alterations in tissues that require frequent cell turnover. The implications of this are particularly severe for the nervous tissue, contributing to spinal cord development issues in fetuses and brain degeneration in the elderly. Additionally, it can negatively impact erythropoiesis, the production of red blood cells, leading to or exacerbating anemia.

Folic Acid Deficiency Anemia

Folic acid deficiency anemia is a common complication arising from the reduced metabolic function of folic acid and/or cobalamin. This condition can occur due to various reasons:

1. Dietary deficiency: As folic acid is heat-sensitive, its nutritional value can be lost when food is cooked. Additionally, some plant-based foods contain molecules that can hinder the absorption of this vitamin, affecting its bioavailability.
2. Impaired absorption: Although rare, this is common in individuals who have undergone surgical resections of parts of the digestive tract, often leading to anemia.
3. Medications: Certain drugs, such as methotrexate, barbiturates, and contraceptives, can disrupt folic acid metabolism. Individuals on such medication need to ensure adequate folate intake to prevent anemia.
4. Genetic factors: Mutations in the MTHFR gene can significantly affect the body’s ability to process folate and homocysteine, thus increasing the risk of developing folic acid deficiency anemia due to reduced enzymatic activity that leads to lower circulating folate levels.

Anemia resulting from folic acid deficiency is characterized by the production of immature, larger, more colored, and less efficient red blood cells. Symptoms often overlap with those of cobalamin deficiency and can include generalized exhaustion, gastrointestinal issues, and neurological symptoms such as numbness, lack of reflexes, and poor motor coordination.