A Case of Megaloblastic Anemia that Developed after Intestinal Tube Feeding for Six Years

Abstract

Megaloblastic anemia is caused by deficiency of folate or cobalamin (vitamin B 12), and is a relatively rare disease in childhood. Here we report a pediatric case of megaloblastic anemia following intestinal tube feeding for 6 years. The patient was a 14-year-old boy. At 7 months of age, he was transported to our hospital in a cardiopulmonary arrest state due to idiopathic gastric rupture, and he developed severe hypoxic-ischemic encephalopathy. At 6 years of age, he was placed a stomach tube because of frequent gastroesophageal reflux. However, the symptoms did not improve. At 8 years of age, he was placed on a intestinal tube for enteral feeding, and gastric juice was drained from a stomach tube. At 14 years of age, he was admitted to our hospital because of edema of the limbs end and gingival bleeding. Laboratory examination on admission revealed pancytopenia and decreased levels of vitamin B 12. He was diagnosed with megaloblastic anemia caused by deficiency of vitamin B 12. He was treated with cyanocobalamin intramuscularly and the blood corpuscle abnormality improved immediately. The clinical course suggests that megaloblastic anemia developed due to the loss of gastric juice containing an intrinsic factor from the gastric tube.