Other Causes

The two other primary causes of nutritional anemia are deficiencies in vitamin B12 and folic acid, both of which are necessary for the production of DNA, RNA, and protein. Without these necessary factors, red blood cells can develop abnormally, or even die prematurely in the bone marrow where they are made. This leads to what is known as megaloblastic anemia.

Folate deficiency is most often caused by poor intestinal absorption or low intake of folate-rich foods, such as human milk, cow's milk, fruits, green vegetables, and certain meats. It is also caused by congenital defects in intestinal absorption. Just as with iron, folic acid requirements are highest during periods of rapid growth, particularly infancy and pregnancy. Folate-deficient children present with common symptoms of anemia, as well as chronic diarrhea. Folate deficiency can also occur with kwashiorkor or marasmus. If it occurs during pregnancy, folate deficiency can lead to neural tube defects, spontaneous abortions, and prematurity.

Vitamin B12, derived from a substance called cobalamin, is mainly found in meats and other animal products—humans cannot synthesize this vitamin on their own. A good amount of its absorption depends on the presence of a substance called intrinsic factor (see sidebar). It does not normally occur with kwashiorkor or marasmus. Both folate and vitamin B12 deficiencies have also been linked to cardiovascular disease, mood disorders, and increased frequency of chromosomal breaks (which may contribute to the development of cancer).

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