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Report questions use of folic acid for sickle cell

By Alison McCook

Last Updated: 2003-05-28 17:00:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - People with sickle cell disease are routinely given supplements of folic acid, but that practice may mask the symptoms of a potentially dangerous deficiency of vitamin B12, researchers said Wednesday.

As evidence, the researchers present the case of a woman with sickle cell anemia taking folic acid who eventually developed neurologic problems, a sign of an unchecked vitamin B12 deficiency.

If people with sickle cell disease are given folic acid supplements, it would be a good idea to regularly measure their vitamin B12 levels, according to a report in The New England Journal of Medicine.

Sickle cell disease is an inherited condition in which normally round red blood cells become "sickled" or shaped like crescents. The abnormally shaped cells can block small blood vessels in the body's organs, restricting their supply of blood and oxygen. In the U.S., the illness is most common among African Americans.

In most cases, doctors give patients with this form of anemia supplements of folic acid, a type of B vitamin, which the body uses to build new red blood cells, Dr. Ralph Carmel of New York Methodist Hospital in Brooklyn told Reuters Health.

Unfortunately, deficiencies in folic acid and vitamin B12 can look alike, he said. In the case of the woman featured in the article, extra folic acid masked the initial symptoms of her vitamin B12 deficiency, but did not protect her from developing neurologic symptoms.

Although instances of vitamin B12 deficiency in sickle cell anemia are likely rare, this case demonstrates that it can occur, said Carmel, who is the lead author of the report. Furthermore, a recent study suggested that supplements of folic acid may offer no benefit to patients with sickle cell anemia, he added.

As a result, Carmel said he believed that routinely giving all patients with sickle cell anemia extra folate "is a waste of time and money."

The 29-year-old woman featured in the current case report developed a deficiency in vitamin B12 because of a second form of anemia known as pernicious anemia, a gastrointestinal illness that prevents the body from absorbing the vitamin from food, Carmel said.

After years of being treated for her sickle cell anemia and taking folic acid supplements, doctors noticed that her anemia was getting worse, and that she appeared confused and had an unsteady gait. She was reportedly also undressing in public, and her children had moved in with relatives because of her strange behavior.

Doctors may not consider the possibility of a vitamin B12 deficiency in their patients with sickle cell anemia, Carmel noted, because this form of anemia traditionally strikes the young, while pernicious anemia is predominantly a disease of the elderly.

However, younger people -- especially African Americans -- do sometimes develop pernicious anemia, the researcher added, and people with sickle cell anemia are living longer than ever before.

Copyright 2002 Reuters.