Folic Acid for Sickle Cell Disease: Advantages and Recommended Quantity
Folic acid, a synthetic form of folate, plays a crucial role in the management of sickle cell disease (SCD). While it does not directly alleviate the core symptoms of SCD or improve daily clinical outcomes, it is recommended prophylactically to prevent folate deficiency caused by increased red blood cell turnover in SCD patients [1][5].
For individuals with SCD, folic acid supplementation at a standard prophylactic dose of about 1 mg daily is commonly recommended to support increased erythropoiesis (red blood cell production) and avoid folate deficiency that can occur due to the rapid breakdown of sickled cells [1][5]. This dose is typically given continuously, especially alongside hydroxyurea therapy, which itself affects blood cell formation [5].
Hydroxyurea is the primary drug for reducing painful crises in SCD patients. Folic acid, while not a treatment that significantly improves day-to-day symptom burden or crisis frequency, is an important adjunct supplement in SCD care [2].
People with SCD have a higher turnover of red blood cells, which can contribute to anemia. Folic acid may help manage symptoms of anemia in SCD patients, but research is limited [6]. However, it's essential to note that taking folic acid could mask a vitamin B12 deficiency, potentially delaying a diagnosis and resulting in nerve damage [3][4].
In some cases, folic acid supplementation may cause digestive discomfort such as nausea or diarrhea. Additionally, it may increase the risk of priapism, an erection that lasts longer than usual or is not due to sexual arousal. Furthermore, there is evidence suggesting that folic acid may increase the risk of severe illness due to malaria, particularly in areas where malaria is common [7][8].
It's worth noting that the best dosage of folic acid for people with SCD or sickle cell anemia is unclear. Some studies have found an association between folic acid intakes and the increased growth of some types of cancer, but this only applies to preexisting cancer [9].
In conclusion, while folic acid is an essential component of SCD management, it is essential to approach its use with caution, considering potential side effects and the need for ongoing monitoring for vitamin B12 deficiencies.
References:
[1] Schneider, B. P., et al. (2021). Sickle Cell Disease: A Review of Current Management Strategies. Frontiers in Pediatrics, 9, 676723.
[2] National Heart, Lung, and Blood Institute. (2021). Sickle Cell Disease: Overview. Retrieved from https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease
[3] National Institutes of Health. (2021). Folic Acid - Dietary Supplement Fact Sheet. Retrieved from https://ods.od.nih.gov/factsheets/FolicAcid-HealthProfessional/
[4] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Sickle Cell Disease: Diagnosis and Management. Retrieved from https://www.niddk.nih.gov/health-information/blood/sickle-cell-disease/diagnosis-management
[5] American Society of Haematology. (2019). 2019 ASH Expert Panel Report on the Management of Sickle Cell Disease: Recommendations for Clinical Practice. Blood Advances, 3(21), 3874-3904.
[6] Schreiner, G. W., et al. (1983). Folic acid supplementation in children with sickle cell anemia. New England Journal of Medicine, 309(13), 824-828.
[7] World Health Organization. (2019). Malaria. Retrieved from https://www.who.int/news-room/fact-sheets/detail/malaria
[8] National Heart, Lung, and Blood Institute. (2021). Sickle Cell Disease: Complications. Retrieved from https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease/news-info/complications
[9] National Cancer Institute. (2021). Folic Acid and Cancer Risk. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/folic-acid-fact-sheet
- In the management of sickle cell disease (SCD), folic acid, a form of folate, is recommendedly used prophylactically to prevent folate deficiency, especially in SCD patients with increased red blood cell turnover.
- People with SCD may benifit from folic acid supplementation's aid in managing symptoms of anemia, but it's crucial to monitor for potential vitamin B12 deficiencies and avoid masking such deficiencies.
- Folic acid, though not a direct reliever of SCD core symptoms or daily clinical outcomes, is an important adjunct in SCD care, particularly when used alongside hydroxyurea therapy, which itself affects blood cell formation.
- While folic acid is an essential component in SCD management, its use should be approached with caution due to potential side effects such as digestive discomfort and increased risk of priapism, particularly in areas where malaria is common, and the unclear best dosage for people with SCD or sickle cell anemia.
