Folate deficiency in acutely ill patients
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Ten cases of rapid onset pancytopenia due to acute folate deficiency, which occurred over a 2 year period are described. All patients were acutely ill and suffered serious haemorrhagic complications as a result of the thrombocytopenia. Where available, serum folate levels were depressed, whereas red cell folate and vitamin B12 levels were normal. Bone marrow aspirate was examined in 8 patients and all showed megaloblastosis.
Therapy with intravenous folate was corrective in all cases, although a variable delay (mean 6 days) was experienced before peripheral counts returned to the normal range.
A review of the cases of acute folate deficiency described in the literature, suggests that the major effect of acute folate depletion is on the platelet series, reflected clinically by the frequency of severe haemorrhagic complications.
The major precipitating factors would appear to be surgery, infection, parenteral nutrition and renal failure, particularly if haemodialysis or peritoneal dialysis is required.
Acute folate deficiency with its ensuing complications, can be life threatening and because of the nature of the disorder, the use of prophylactic folate supplements may be warranted in susceptibe patients.
KeywordsFolate Peritoneal Dialysis White Cell Count Bone Marrow Aspirate Mean Corpuscular Volume
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