Abstract
A 68-year-old female was admitted to the hospital because of severe anemia. She had a history of cerebral hemorrhage and had taken phenytoin and phenobarbital in combination for 12 years. Severe macrocytic anemia was noted with elevated LDH and reduced serum folate, Blood smear showed neutrophil hypersegmentation. Bone marrow smear showed erythroid hyperplasia with remarkable megaloblastic changes. These observations led to the diagnosis of megaloblastic anemia due to folate deficiency. The anemia improved after folic acid supplements without withdrawal of the anticonvulsants. The decrease of dietary folate intake had effected the development of hematological abnormality associated with folate deficiency, such as neutrophil hypersegmentation and macrocytosis, since her activity of daily living (ADL) function dropped in 1993. In patients receiving anticonvulsant medication, low serum folate levels are relatively common. However, overt anemia is unusual. Dietary f olate inadequency is the most important facter contributing to anemia.We emphasize that in patients who have the decrease of dietary folate intake during therapy with anticonvulsants, neutrophil hypersegmentation and macrocytosis should be detected before severe anemia occurs.
