We have intensively studied an apparently well-fed 10-year-old child with sickle cell disease who had four episodes of folic acid deficiency in 21/2 years. The first two episodes were characterized by megaloblastic changes in the blood cells.
Lack of weight gain which occurred during all four episodes preceded hematological changes and correlated well with the biochemical indices of folic acid deficiency. Faulty intestinal absorption and excessive urinary excretion of folic acid were apparently not involved. The patient was on a dietary regimen which would have prevented the deficiency in a normal child.
Lopez R, Shimizu N, Cooperman JM. Recurrent Folic Acid Deficiency in Sickle Cell Disease. Am J Dis Child. 1973;125(4):544-548. doi:10.1001/archpedi.1973.04160040052011