# Folic Acid in the Treatment of Sickle Cell Disease: A Systematic Review

## TL;DR

This systematic review examines the role of folic acid in treating sickle cell disease, finding that while it is commonly used, it does not significantly improve clinical outcomes.

## Contribution

The study provides a comprehensive analysis of folic acid's role in SCD treatment, highlighting the lack of evidence for clinical benefits beyond maintaining normal folate levels.

## Key findings

- Most SCD patients receive folic acid supplements, with increased or normal plasma folate levels.
- Folic acid does not significantly affect hemoglobin levels, infections, or pain crises in SCD patients.
- More large clinical trials are needed to determine folic acid's potential benefits in managing SCD.

## Abstract

Sickle cell disease (SCD) is a group of inherited genetic disorders that is caused by a mutation in the gene that codes for hemoglobin subunit β. This systematic review aimed to evaluate the effect of folic acid in the treatment of SCD patients. We retrieved 3730 articles from PubMed, PubMed Central, Google Scholar, and ScienceDirect databases. We employed a search technique that involved framing keywords, such as folic acid, folate, and sickle cell illness, and the Medical Subject Headings (MeSH) strategy in PubMed. We chose research articles that had been published during the last 10 years, as well as case reports, systematic reviews and meta-analyses, literature reviews, randomized controlled trials, and observational studies. Exclusion criteria included paid full-text articles, abstracts, non-English studies, and patients who do not have SCD. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used in the design of our systematic review. It was found that the majority of SCD patients were receiving regular folic acid supplements and that their plasma folate levels were either increased or within normal range, with no discernible impact on other clinical outcomes such as hemoglobin levels, infections, or pain crises. SCD patients produce more red blood cells than healthy individuals, and nearly all SCD patients receive daily folic acid supplements. On the other hand, not enough information is available on folic acid's potential benefits in the management of SCD; thus, there is a need for more large clinical trials.