Etiopathogenesis, Clinical Features, and Management of Vitamin B12 and Folate Deficiency Anemia

Etiology of Folate Deficiency Anemia

Folate deficiency anemia arises due to insufficient levels of folate, a crucial water-soluble B vitamin, affecting erythropoiesis. The primary etiological factors include inadequate dietary intake, impaired absorption, increased physiological demand, and drug-induced depletion.

Causes of Folate Deficiency

• Inadequate dietary intake: Common in malnourished individuals, alcoholics, and the elderly.
• Malabsorption disorders: Conditions such as celiac disease and tropical sprue hinder folate absorption.
• Increased demand: Pregnancy, lactation, and hemolytic anemia elevate folate requirements.
• Drug-induced deficiency: Certain medications, including methotrexate and phenytoin, interfere with folate metabolism.

Clinical Manifestations

Patients with folate deficiency anemia exhibit symptoms such as pallor, fatigue, glossitis, and neurological manifestations like cognitive impairment, though less pronounced compared to vitamin B12 deficiency.

Diagnostic Approach

Diagnosis involves evaluating serum folate levels, complete blood count revealing macrocytic anemia, and ruling out vitamin B12 deficiency through methylmalonic acid and homocysteine levels.

Management

Treatment focuses on folate supplementation, dietary modifications emphasizing green leafy vegetables, and addressing underlying etiological factors.