Folate, also called folic acid, is necessary for red blood cell formation and growth. Folate can be obtained from green leafy vegetables and liver. Some medications, such as Dilantin, interfere with the absorption of this vitamin. Because folate is not stored in the body in large amounts, a continual dietary supply of this vitamin is needed.

In folate deficiency anemia, the red cells are abnormally large and are referred to as megalocytes, and in the bone marrow as megaloblasts. Subsequently, this anemia may be referred to as megaloblastic anemia

Causes of the anemia are poor dietary intake of folic acid as in chronic alcoholism, malabsorption diseases such as celiac disease and sprue, and certain medications. A relative deficiency due to increased need for folic acid may occur in the third trimester of pregnancy.

Risk factors are a poor diet (seen frequently in the poor, the elderly, and in people who do not buy fresh fruits or vegetables), overcooking food, alcoholism, having a history of malabsorption diseases, and pregnancy. The disease occurs in about 4 out of 100,000 people.

• Tiredness
• Headache
• Sore mouth and tongue
• Pallor

• Low red blood cell folate level.
• A complete blood count shows anemia and large red blood cells.
• A bone marrow examination is rarely necessary, but shows megaloblasts.