MEGALOBLASTIC-ANEMIA IN PATIENTS RECEIVING TOTAL PARENTERAL NUTRITION WITHOUT FOLIC-ACID OR VITAMIN-B12 SUPPLEMENTATION

  • 1 January 1977
    • journal article
    • research article
    • Vol. 117  (2) , 144-146
Abstract
Pancytopenia developed in 4 patients receiving postoperative total parenteral nutrition (TPN). Symptoms and signs were related mainly to underlying bowel disease. Hematologic abnormalities, 1st noted from 4-7 wk following institution of TPN, consisted of normocytic anemia (mean decrease in Hb value, 2.2 g/dl), occasional macrocytes being noted, leukopenia (range of leukocyte counts, 1.2-3.6 .times. 109/l), some hypersegmented neutrophils being detected, and clinically significant thrombocytopenia (range of platelet counts, 25-52 .times. 109/l). In all patients the bone marrow showed megaloblastic changes, with ring sideroblasts, although pyridoxine was included in the TPN regimens. Serum vitamin B12 values were normal in 1 patient and at the lower limit of normal in the other 2 patients in whom it was measured, while serum or erythrocyte folate values, or both, were reduced in 3 patients. Full hematologic response was observed in the 4 patients after folic acid replacement therapy; leukocytosis and thrombocytosis were noted in 3. Folic acid and possibly vitamin B12 should be added routinely to TPN regimens to prevent deficiency of either substance.