A case of megaloblastic anemia due to folic acid deficiency and vitamin-K-dependent bleeding during treatment of infant leukemia

Abstract

A 4-year-old boy with poor oral intake lost weight during maintenance therapy for infantile acute lymphocytic leukemia. Immediately before completion of the maintenance therapy, he contracted norovirus enteritis and experienced progressive weight loss resulting in hospitalization. Tube feedings and continuous administration of replacement fluids were started. Folic acid deficiency caused megaloblastic anemia, requiring folic acid supplementation. Later, vitamin K deficiency caused a subdural hematoma necessitating vitamin K supplementation and emergency removal of the hematoma. Additionally, parenteral nutrition was started, the patient gained weight, and his oral intake improved. The patient developed megaloblastic anemia and hemorrhagic disease due to vitamin K deficiency in the presence of various coexisting factors including primary disease treatment, the condition of his home environment, and the occurrence of norovirus enteritis. Such complications rarely develop during the treatment of leukemia, and our report emphasizes the importance of nutritional assessment.