Folate deficiency in acutely ill patients
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
- Amess, J. A. L., Burman, J. F. and Mollin, D. L. 1976. Folic acid deficiency during intensive therapy. Br. Med. J. i, 525 (Letter).Google Scholar
- Amos, R. J., Amess, J. A., Hinds, C. J. and Mollin, D. L. 1982. A study of megalobastic change in developing in patients receiving intensive care. Br. J. Haematol. 51, 329 Abstr.Google Scholar
- Beard, M. E. J., Hatipov, C. S. and Hamer, J. W. 1978. Acute marrow folate deficiency during intensive care. Br. Med. J. i, 624–625.Google Scholar
- Denburg, J., Bensen, W., Ali, M. A. M., McBride, J. and Ciok, J. 1977. Megaloblastic anaemia in patients receiving total parenteral nutrition without folic acid or vitamin B12 supplementation. Can. Med. Ass. J. 117, 114–146.Google Scholar
- Hampers, C. L., Streiff, R., Nathan, D. G., Snyden, D. and Merrill, J. P. 1967. Megaloblastic haematopoiesis in uremia and in patients on long term haemodialysis. N. Eng. J. Med. 276, 551–554.Google Scholar
- Hassmi, K. Z. 1979. Folate deficiency in a surgical patient. J.P.M.A. 11, 242–245.Google Scholar
- Herbert, V. 1962. Experimental nutritional deficiency in man. Trans. Ass. Am. Physns. 75, 307–320.Google Scholar
- Hillman, R. S., McGuffin, R., Campbell, C. 1978. Alcoholic interference with folate enterohepatic cycle. Trans. Ass. Physns. 91, 145–156.Google Scholar
- Ibbotson, R. M., Colvin, B. T., and Colvin, M. P. 1975. Folic acid deficiency during intensive therapy. Br. Med J. iv, 145.Google Scholar
- Ibbotson, R. M., Colvin, B. T., Colvin, M. P. 1975. Folic acid deficiency during intensive therapy. Br. Med. J. iv, 522 (Letter).Google Scholar
- Kipple, J. D., Swainseid, M. E. 1975. Vitamin nutrition in patients undergoing maintenance dialysis. Kidney Int. 7, 79–84.Google Scholar
- Saary, M. and Hoffbrand, A. V. 1976. Folic acid deficiency during intensive therapy. Br. Med. J. i, 461 (Letter).Google Scholar
- Scott, J. M., Ghanta, V., Herbert, V. 1974. Trouble free microbiologic serum and red cell folate assays. Am. J. Med. Technology 40, 125–134.Google Scholar
- Sevitt, L. H. and Hoffbrand, A. V. 1969. Serum folate and vitamin B12 levels in acute and chronic renal disease. Effect of peritoneal dialysis. Br. Med. J. ii, 18–21.Google Scholar
- Smith, R. C., Tennant, G. G., Williams, R. H. P., Wardrop, C. A. J. and Hughes, L. E. 1978. Acute depression of serum folate due to ethanol free parenteral nutrition and surgical trauma. Br. J. Surg. 65, 364.Google Scholar
- Wardrop, C. A. J., Lewis, M. H., Tennant, G. B., Williams, R. H. P. and Hughes, L. E. 1977. Acute folate deficiency in surgical patients on amino acid/ethanol intravenous nutrition. Lancet ii, 640–642.Google Scholar
- Wicknamasungle, S. N. 1981. Review: The Deoxyuridine suppression test: a review of 5 clinical and research applications. Clin. Lab. Haematol. 1: 1.Google Scholar