1981 Volume 18 Issue 6 Pages 450-455
A patient associated with megaloblastic anemia due to folate deficiency caused by the tube feeding is described.
An 86-year-old woman was admitted to Tokyo Metropolitan Geriatric Hospital because of consciousness disturbance, right hemiparesis and motor aphasia. She was diagnosed as cerebral vascular disease and was treated conservatively. On admission the hemoglobin level was 12.4g/dl and morphological findings of red cells were within normal limits. Nasogastric tube feeding was begun, which contained 1545 Cal daily (protein 69.6g, sugar 44.2g, fat 182g, folic acid 60μg). Seven months later, the hemoglobin level fell to 6.9g/dl with macrocytosis. A bone marrow aspirate revealed megaloblastic changes and giant metamyelocytes. The serum folic acid activity was 0.90ng/ml, the vitamine B12 level 440pg/ml, and the serum iron level was 118μg/dl. Although some drugs such as INH, anticonvulsant and glutethimide, are known to give rise to megalblastic anemia, she was not given any of these, except antihypertensive drugs. Thus, the insufficient daily intake of the folate was considered to be the cause of the megaloblastic anemia. She was treated with folic acid 30mg/day through nasogastric tube following the elevation of the hemoglobin level to 8.3g/dl in two manths.
Including this case, six patients feeded with the diet of the same composition through nasogastric tube were examined hematologically. After the duration of the tube feeding of 17.3±8.0 months, their serum folic acid activity had become under normal value (0.93±0.14ng/ml). They responded to the treatment with 30mg of folic acid daily, and their hemoglobin level and folic acid activity increased significantly.
