# Folate Deficiency Anaemia - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 · Cyanocobalamin DailyMed label, SetID 41ac0dc1-0a71-4c69-8e25-ba838f5f16a3, dosage and administration - Verified date: 2026-08 ## Verified against - BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 - Folate Deficiency Anaemia - disease-level clinical article (folate-deficiency-anaemia-clinical.txt) ## Treatment metadata - Folic acid — 5 mg — oral.solid - Referral & safety-netting (no drug therapy) - Cyanocobalamin — injection ## Complete treatment card ```text FOLATE DEFICIENCY ANAEMIA Sources: BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 · Cyanocobalamin DailyMed label, SetID 41ac0dc1-0a71-4c69-8e25-ba838f5f16a3, dosage and administration Review status: REVIEWED against BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014, Folate Deficiency Anaemia - disease-level clinical article (folate-deficiency-anaemia-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Not eating enough folate-rich food, such as leafy greens, legumes, and citrus, is a common cause [poor appetite] - Certain medicines - methotrexate, phenytoin, trimethoprim, and sulfasalazine among them - can interfere with folate absorption or how the body uses it - Long-term heavy drinking disrupts both folate absorption and how the liver processes it - Pregnancy, breastfeeding, hemolytic anemia, and skin conditions that shed cells quickly all raise the body's folate needs [anaemia] - Unlike a B12 deficiency, this condition on its own generally does not cause tingling, poor balance, or loss of position sense [unsteadiness] SIGNS - what you find (4) - A smooth, red, painful tongue with mouth ulcers can be found [mouth ulcers] - Pallor and tiredness reflect the underlying anemia [anaemia · fatigue · pallor] - Mild yellowing of the eyes can appear from breakdown of the fragile, abnormally large red cells - Irritability, forgetfulness, and mood changes can occur, especially in older adults, even without a clear neurological deficit [irritability · memory loss] TESTS (7) - A complete blood count shows macrocytic anemia with MCV over 100 fL, low hemoglobin and hematocrit, mildly raised or normal MCH, and a typically normal MCHC - The reticulocyte count usually runs low, reflecting poor red cell production - A blood smear shows large red cells, neutrophils with extra nuclear lobes, and sometimes megaloblasts - A serum folate under 2 ng/mL confirms deficiency, 2 to 4 ng/mL is borderline, and above 4 ng/mL is generally normal - Raised homocysteine with a normal MMA and normal B12 points to this deficiency, while both markers raised with low B12 points instead to a B12 deficiency - Red-cell folate reflects longer-term status, and a low value points to a chronic deficiency - Bone marrow biopsy is not routinely needed but can show a hypercellular marrow with megaloblastic change if it is done for another reason IF NOT THIS - what else fits (4) - Vitamin B12 deficiency and alcoholic liver disease are also on the differential - Hypothyroidism and myelodysplastic syndromes are also considered - Aplastic anemia and drug-induced macrocytosis are on the list - Hemolytic anemias and copper deficiency round out the differential Source StatPearls "Folic Acid Deficiency" - disease-level clinical article Status traced to the source above Rx: Main treatment | Correct a co-existing B12 deficiency first MAIN TREATMENT - choose one 1. FOLIC ACID [1st line] Adult 5 mg once daily x 4 months (until anaemia resolved and tissue stores replenished) Peds 1 year and over: 5 mg once daily (Children <1 year: 500 mcg/kg once daily (max 5 mg); Children >=1 year: 5 mg once daily) Source BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 Why Corrects the folate deficiency responsible for this anaemia; it must not be started until the alternative vitamin deficiency noted in the cautions has been ruled out, because treating folate deficiency alone in that situation can precipitate irreversible neurological damage rather than prevent it. Caution CRITICAL SAFETY RULE: EXCLUDE VITAMIN B12 DEFICIENCY BEFORE STARTING FOLIC ACID. Administering folic acid alone to B12-deficient patients improves anaemia but precipitates or worsens irreversible subacute combined degeneration of the spinal cord. Identify and correct underlying cause (malnutrition, coeliac disease, malabsorption, antifolate drugs like methotrexate/phenytoin). Egypt FOLIC ACID (EL NILE) 5 MG 50 TAB. EL NILE. 26.25 EGP (0.53/unit) FOLIC ACID (MEMPHIS) 5 MG 30 TAB. MEMPHIS 15.75 EGP (0.53/unit) FOLICINAD 5 MG 50 TABS. INAD PHARMA 50.00 EGP (1.00/unit) FOLIC ACID (EIPICO) 5 MG 20 TAB. EIPICO 24.00 EGP (1.20/unit) FOLIC ACID (EL NILE) 5 MG 30 TAB. EL NILE. 36.00 EGP (1.20/unit) FOLIRAQ 5000 MCG 30 CAPSULES HP PHARMA 45.00 EGP (1.50/unit) FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML MADDOX PHARMA 150.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Folate Deficiency Anaemia - disease-level clinical article (folate-deficiency-anaemia- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Vitamin B12 deficiency must be ruled out or co-treated prior to or alongside folic acid supplementation, to prevent exacerbation of neurological complications. CORRECT A CO-EXISTING B12 DEFICIENCY FIRST - give alongside 3. CYANOCOBALAMIN [add-on - not a substitute] Adult 100 mcg by intramuscular or deep subcutaneous injection daily for six or seven days; the label then lengthens the interval step by step before settling at 100 mcg monthly for life Peds No paediatric treatment dose in the sources opened; the label gives only the daily dietary requirement for children. Source Cyanocobalamin DailyMed label, SetID 41ac0dc1-0a71-4c69-8e25-ba838f5f16a3, dosage and administration - verbatim: "A dose of 100 mcg daily for six or seven days should be administered by intramuscular or deep subcutaneous injection." Why Measure B12 before starting folic acid. Treating the folate alone repairs the blood count while the nerve damage of an untreated B12 deficiency keeps advancing, which is why this belongs on the folate card rather than only on its own. Caution Do not give this by the intravenous route - the label warns that almost all of the vitamin is then lost in the urine. Do not use in anyone sensitive to cobalt or to vitamin B12 itself. The label sets a tapering schedule between the loading course and monthly maintenance; follow it and recheck the blood count rather than jumping straight to monthly injections. Egypt CIDOLVEX 1MG/ML I.M AMP. CID 5.20 EGP BETO-12 1MG/ML 2 AMP. AMOUN 11.00 EGP RUBIVAMIN 1000 MCG 5 AMPS. MISR 42.50 EGP BETOLVEX 1MG/ML 2 AMPS. I.M. MINA PHARM 64.00 EGP BETOLVEX 1MG/ML 2 PRE-FILLED SYRINGE I.M. MINA PHARM 110.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. 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