Folic Acid Supplementation in Sickle Cell Disease

Critical Considerations

• Before initiating folic acid supplementation, always exclude vitamin B12 deficiency first, as folic acid can mask B12 deficiency hematologically while allowing neurological complications to progress, according to Clinical Nutrition 1, 2, 3, 4, 5, 6, 7
• Folic acid can mask B12 deficiency hematologically while allowing neurological complications (subacute combined degeneration of the spinal cord) to progress, as noted by Obesity Reviews and Clinical Nutrition 1, 4, 7
• Check both serum B12 and folate levels before starting treatment, as recommended by Clinical Nutrition 2, 3
• In diseases with increased folate needs (including sickle cell disease), folate status can be measured every 3 months until stabilization, then annually, according to Clinical Nutrition 2, 3
• The cost of folic acid supplementation is minimal and adverse effects at 1 mg daily are negligible, as stated by Clinical Nutrition 2
• Consider that most excess folic acid will be excreted in urine, making toxicity unlikely at this dose, as noted by Clinical Nutrition 2, 4, 5