Folic Acid (Folate)
Folate is a B vitamin essential for DNA synthesis and red blood cell production. Deficiency can cause megaloblastic anaemia and, during pregnancy, increase the risk of neural tube defects. No fasting required.
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What the Folic Acid (Folate) test tells you
Folate, also called vitamin B9, is needed whenever the body builds new DNA, and it does that fastest in the bone marrow, the lining of the gut and a developing baby. The body cannot make folate and stores only a modest amount, mostly in the liver, so a period of poor intake or increased demand depletes it within months rather than years. This test measures the folate circulating in your blood.
When folate runs short, the bone marrow cannot divide red cell precursors properly and produces red cells that are too large and too few, a pattern known as megaloblastic anaemia. It causes tiredness, breathlessness, pallor and sometimes a sore tongue. Vitamin B12 works in the same pathway and produces an identical picture in the blood, which is why the two are almost always measured together. That overlap carries a genuine safety warning: giving folate to someone whose real problem is B12 deficiency can correct the anaemia and make the person look treated, while the nerve damage of untreated B12 deficiency continues silently. For that reason folate should never be taken to treat an unexplained anaemia without B12 being checked first.
The other major context is pregnancy. The neural tube, the structure that becomes the brain and spinal cord, forms and closes in the earliest weeks, often before a pregnancy is confirmed. Adequate folate at that moment substantially reduces the risk of serious neural tube defects such as spina bifida, which is why supplementation is advised before conception rather than after a pregnancy is discovered. Folate is also one of the vitamins required to clear homocysteine from the blood, so a low level is a common explanation for a raised homocysteine result.
Ordered when megaloblastic anaemia is suspected, during pregnancy planning or early pregnancy, and when homocysteine levels are elevated.
- Investigates large-cell anaemia
When red cells are fewer and larger than usual, folate and vitamin B12 are the first deficiencies to exclude, and both are checked together.
- Supports pregnancy planning
Folate status is assessed before and in early pregnancy, when demand is highest and the timing genuinely matters.
- Explains raised homocysteine
Folate is required to clear homocysteine, so a shortage is a common reason for a raised result.
- Assesses absorption problems
Coeliac disease, inflammatory bowel disease and previous gut or stomach surgery all reduce how much folate is taken up.
Reasons your doctor may request the Folic Acid (Folate) test
Your doctor may order this test for any of the reasons below. Some are routine checks, others follow specific symptoms or an earlier result.
Anaemia & raised homocysteine
- A blood count has shown anaemia with unusually large red cells.
- A homocysteine result has come back raised and its cause is being sought.
Planning a pregnancy
- You are planning a pregnancy or are in the early weeks of one.
Absorption, medication & diet
- You have coeliac disease, inflammatory bowel disease or have had bowel or stomach surgery.
- You take methotrexate, certain anticonvulsants or other medicines that interfere with folate.
- Long-term heavy alcohol use or a very restricted diet makes deficiency likely.
A result in the "Low" ng/mL band suggests intake or absorption has not kept up with demand: a diet short of green vegetables, pulses and fortified foods, coeliac or inflammatory bowel disease, pregnancy or breastfeeding, heavy alcohol use, or medicines such as methotrexate. A "Normal" ng/mL result reflects recent intake more than tissue stores, so a supplement dose or a folate-rich meal shortly before the sample can lift a genuinely low level into this band. A "High" ng/mL reading is usually supplements or fortified food and is not typically harmful, though it can also appear when vitamin B12 is deficient and folate cannot be used properly. Folate is never read alone. Correcting it while a vitamin B12 deficiency goes unnoticed allows nerve damage to progress, so your doctor interprets it with your B12 result, your blood count, your symptoms and your history.
Medically reviewed by Dr Nirupama Sabhapathy
Ranges are a guide: your physician interprets your result alongside your symptoms and history.
What a higher result can point to
- Folic acid or multivitamin supplements, particularly a dose taken shortly before the sample.
- A diet rich in fortified cereals and flour products, leafy greens and pulses.
- A recent blood transfusion, which introduces folate from donor cells.
- Vitamin B12 deficiency, where folate cannot be used properly and accumulates in the blood.
What a lower result can point to
- A diet low in green vegetables, pulses and fortified foods.
- Malabsorption from coeliac disease, inflammatory bowel disease or gastric surgery.
- Pregnancy and breastfeeding, which raise demand substantially.
- Chronic heavy alcohol use, which impairs both intake and handling of folate.
- Medicines that block folate metabolism, including methotrexate and some anticonvulsants.
- Conditions with rapid cell turnover, such as ongoing haemolysis, which consume folate quickly.
These are possibilities, not diagnoses. A single value outside the reference range is interpreted alongside your symptoms, history and other tests: your doctor decides what it means for you.
What this test cannot tell you
- Taking folate can correct the anaemia of vitamin B12 deficiency while the neurological damage of that B12 deficiency continues unnoticed, so folate must never be interpreted or treated without a B12 result alongside it.
- Serum folate reflects recent intake, so a supplement dose or a folate-rich meal shortly before the sample can raise the result and mask a real deficiency.
- It measures folate circulating in blood rather than what is stored in tissue, so a single result may not represent longer-term status.
- Fortification of flour and cereals in many countries has made frank deficiency less common, so results are always read against the clinical picture.
Risks of the blood draw
- Mild bruising or brief soreness where the needle went in.
- Occasional lightheadedness, which settles after a few minutes of rest.
- Bleeding or infection at the site, which is rare with sterile single-use equipment.
- 1Folate is essential for DNA synthesis and is used most heavily by rapidly dividing tissue.
- 2Correcting folate alone can hide vitamin B12 deficiency while nerve damage progresses, which is why the two are always assessed together and folate is not taken for an unexplained anaemia before B12 is checked.
- 3Adequate folate before conception and in the earliest weeks substantially reduces the risk of serious neural tube birth defects.
- 4Stores are limited, so deficiency can develop over months of poor intake or high demand.
- 5The result reflects recent intake, which is why supplement timing before the sample is discussed with you.
Folic Acid (Folate) also comes in these focused packages, which pair it with the tests usually read alongside it.
- Vitamins & MineralsVitamin B12 (Cyanocobalamin)
Vitamin B12 is essential for nerve function, DNA synthesis, and red blood cell production. Deficiency can cause anaemia, neurological damage, and…
50View - Vitamins & MineralsHomocysteine, Quantitative
Homocysteine is an amino acid that, when elevated, increases the risk of cardiovascular disease, blood clots, and stroke. High levels may reflect…
150View - HaematologyComplete Blood Count (CBC)
The CBC is the most commonly ordered blood test. It measures red blood cells, white blood cells, haemoglobin, haematocrit, and platelets to assess…
35View - HaematologyHemoglobin (Hb)
Haemoglobin is the oxygen-carrying protein in red blood cells. This test measures haemoglobin levels to detect anaemia, polycythemia, or monitor…
25View
Frequently Asked Questions
Everything you need to know about the Folic Acid (Folate) test. Can't find what you're looking for?
Talk to our team→Our laboratory reports 3.1 to 20 ng/mL as normal. A result of 3 ng/mL or below is low and may lead to anaemia. Above 20 ng/mL is reported as high and is usually from supplements or fortified food. Because serum folate reflects recent intake, a normal result is read with your diet, supplements and B12 result.
Folate deficiency mainly shows through megaloblastic anaemia, causing tiredness, weakness, breathlessness on exertion and pale skin, and sometimes a sore tongue or mouth ulcers. Vitamin B12 deficiency causes the same blood changes and can also damage nerves, so your doctor checks both before treating.
The commonest causes are a diet short of green vegetables, pulses and fortified foods, and malabsorption from coeliac disease, inflammatory bowel disease or gastric surgery. Pregnancy and breastfeeding raise demand, heavy alcohol use impairs intake and handling, and medicines such as methotrexate and some anticonvulsants block folate metabolism. Ongoing haemolysis also uses it up quickly.
Usually not. A high result most often reflects folic acid or multivitamin supplements, especially a dose taken shortly before the sample, or a diet rich in fortified foods. It can also follow a recent blood transfusion, or appear when vitamin B12 is deficient and folate cannot be used properly, which is why B12 is checked alongside it.
Folate is needed to clear homocysteine from the blood, so a shortage of folate is one of the common reasons homocysteine builds up. Vitamin B12 works in the same pathway, which is why a raised homocysteine is usually followed by both a folate and a B12 test before any treatment is chosen.
The two vitamins work in the same pathway and a shortage of either produces identical changes in the blood count. Treating folate while B12 remains low can clear the anaemia while nerve damage progresses unnoticed, so both are measured before anything is given.
It can. A recent dose raises the level in blood for a while and may make your stores look adequate when they are not. Where possible the dose is held until after the sample is taken.
The structure that becomes the brain and spinal cord forms and closes in the first weeks, often before a pregnancy is known about. Folate needs to be adequate at that point, which means starting beforehand.
For many people, yes, since leafy greens, pulses, citrus fruit and fortified cereals are good sources. Whether food alone is enough depends on the cause, and with malabsorption or certain medicines it usually is not.
Not for folate itself, although it is often drawn with tests that do need fasting, so follow the instruction for the whole request. A morning sample is preferred. If you take folic acid or a multivitamin, ask your doctor whether to hold that morning's dose until after the blood is taken.
The folate test is AED 55, including a physician-reviewed report, with results usually within 24 hours. Home collection anywhere in Dubai is free when your order reaches AED 300 or includes a package; below that, a AED 100 home collection fee applies (AED 50 for a lab walk-in).