From the Guidelines
The treatment for low folate levels with high mean corpuscular volume (MCV) is folic acid supplementation, typically 1-5 mg orally daily for at least 4 months or until the underlying cause is addressed, as recommended by the most recent guidelines 1. When treating low folate levels with high MCV, it is essential to first check and treat for vitamin B12 deficiency to avoid precipitation of subacute combined degeneration of the spinal cord 1.
Key Considerations
- Folic acid supplementation should be given orally, with a dose of 1-5 mg daily, and treatment should last for at least 4 months or until the underlying cause is corrected 1.
- Patients with severe deficiency or malabsorption issues may require higher doses of folic acid.
- Dietary intake of folate-rich foods, such as leafy greens, citrus fruits, beans, and fortified grains, should also be increased.
- Complete blood counts should be monitored to ensure improvement in MCV values and hemoglobin levels, with most patients showing normalization of blood parameters within 4-8 weeks of treatment.
Identifying and Addressing Underlying Causes
- The underlying cause of folate deficiency should be identified and addressed, which may include malnutrition, alcoholism, malabsorption disorders, certain medications, or increased requirements during pregnancy.
- Some medications, such as anticonvulsants, sulfasalazine, and methotrexate, may affect folic acid levels and should be considered when treating folate deficiency 1.
From the FDA Drug Label
INDICATIONS AND USAGE Folic acid is effective in the treatment of megaloblastic anemias due to a deficiency of folic acid (as may be seen in tropical or nontropical sprue) and in anemias of nutritional origin, pregnancy, infancy, or childhood. The treatment for low folate and high MCV (Mean Corpuscular Volume) is folic acid supplementation.
- Folic acid is used to treat megaloblastic anemias due to folic acid deficiency, which is consistent with low folate and high MCV levels. 2
From the Research
Treatment for Folate Deficiency and High MCV
- The treatment for folate deficiency with high Mean Corpuscular Volume (MCV) involves addressing the underlying cause of the deficiency 3.
- Therapy may include vitamin supplementation, such as folic acid, to treat the deficiency 3.
- It is essential to diagnose and treat the underlying cause of the folate deficiency, as other conditions, such as cobalamin (vitamin B12) deficiency, may also be present 3.
- Folate and vitamin B12 deficiencies can result in macrocytic anemia, and treatment should focus on correcting the specific deficiency 4, 5.
- Determining a hematologic cutoff value for vitamin B12 and folate may help physicians in clinical practice, as increased anemia and macrocytosis are observed at values below commonly used lower-reference thresholds 5.
- In seniors with low vitamin B12 status, high serum folate was associated with anemia and cognitive impairment, highlighting the importance of addressing both deficiencies 6.