1986 Volume 27 Issue 1 Pages 90-94
Megaloblastic anemia due to folate deficiency in 9 patients is reported. In 6 of these patients, the condition developed during either intravenous hyperalimentation or nasogastric tube feeding, whereas in 2, it occurred as a complication of their hematological diseases. Only one was associated with pregnancy. The major cause of deficiency was ascribed to complete cessation of folate intake in 7 patients, and to increased requirment in 2 patients.
Florid megaloblastic changes were documented in all patients and deoxyuridine (UdR) suppression values were abnormally elevated in all cases so examined. In vitro 3H-UdR incorporation by bone marrow cells improved significantly (to 115∼153% of control) by the addition of folate, but not by vitamin B12. The interval between the start of artificial nutrition and overt megaloblastosis ranged from 5 to 16 weeks with median of 7 weeks. Marked thrombocytopenia below 30×103/ul was noted in 3 of 6 patients with the underlying disorders unrelated to blood dyscrasias. The degree of macrocytosis was less obvious in these 9 patients as compared with that in B12 deficiency.
The frank folate deficiency is a relatively rare condition under the ordinary circumstances. These experiences, however, clearly indicate that the artificial nutrition without deliberate folate supplement, if prolonged, should be listed as a potential cause of megaloblastic anemia accompanied by some distinct hematological features.
