What is Folic acid deficiency anemia how it occur.

Deficiency of folic acid in our body not only causes the serious disease like anemia, but also causes malformed spinal tubes (neural tube defects) spina bifida, in the newborn baby whose mother has folic acid deficiency. Folic acid causes expression of genes that code for proteins and closure of neural tube.

Folic acid directly affects the genes responsible for protein synthesis for cellular membranes and intracellular proteins. Deficiency of folic acid is also responsible for preterm birth. Gastric ulcers and ulceration in mouth.

Folic acid deficiency not only affects the blood cell formation. Deficiency of folic acid also increases the risk of cancers of breast, colorectal, ovarian, pancreatic, brain, lung, cervical, and prostate.

Folic acid biochemistry:

Folic acid on absorption in the body gets converted into tetrahydrofolic acid the folate. Folate actually takes part in formation of amino acids and protein chain elongation. RNA and DNA nucleic acid bases biosynthesis, and cell wall proteins synthesis. Without folic acid many amino acids and nucleic acids are not biosynthesised. This causes defective cell formation just like red blood cells in megaloblastic anemia,  or causes death of cells (Apoptosis).

In our body Folic acid is converted in to Tetrahydrofolic acid which is the active form of folic acid that take part in various biosynthesis of amino acids and nucleic acids . which is also called folate.

Folic acid is contraindicated in patients on antibiotic treatment of antimicrobial drugs after surgery or for serious infections. Folic acid should not be given to patients before diagnosis of type of anemia. Specialy In treatment of Megaloblastic anemia until the type of anemia is diagnosed. If the type of anemia is not identified then folic acid should be avoided till the diagnosis since it may result in false negative result leaving the pernicious anemia or megaloblastic anemia undetected.

How to treat folic acid deficiency anemia?

For patients with megaloblastic anemia supplement of folic acid 4 mg daily and cyanocobalamin Vit. B12 once in a month by IM daily dose or as required. Oral dosage form of folic acid tablets and multivitamin iron and vitamin B12 supplement tablets can be prescribed to patients who have no other gastric absorption problems. Viz  atrophic gastritis and ulcerations. Patients with GIT ulcerations should be given IV dosage of Vitamin B12 and Folic acid.

Drug induced folic acid deficiency:

Many antimicrobial drugs developed to treat serious pathogenic infections are designed to inhibit folic acid synthesis in bacteria. The mode of action to inhibit the folic acid biosynthesis in bacteria is similar in human and microorganisms. The drug when used to treat the infection results in folic acid deficiency.

Example : sulfasalazine, and trimethoprim, Sulfamethoxazole Sulfanilamide.

Anticancer drug that affect the folic acid level in body: Methotrexate.

Other drugs affecting folic acid in the body : Phenytoin which is an anti epileptic drugs.

Folic acid deficiency anema caused due to Enzyme deficiencies:

Enzymes responsible for folic acid biosynthesis are deficient and can produce folic acid deficiency.

Methylenetetrahydrofolate reductase enzyme, responsible for converting folic acid to folate. It is the active form, its deficiency can cause folate deficiency and can also cause anemia.

Deficiency of methionine synthatase enzymes involved in conversion of folic acid to folate . Due to which folic acid is excreted through urine and subsequently cause folate deficiency.

Referances:

https://www.fda.gov neutritional facts