A Case of Pancytopenia Caused by Folic Acid Deficiency During Treatment With Central Venous Nutrition.

Abstract

A 62-year-old woman was admitted to the hospital for acute pancreatitis and underwent sustained intraarterial infusion therapy and drainage for pseudocyst of the pancreas. She needed fasting and long term central venous nutrition and was administered MVI as a multivitamin.On 4th month after admission, she developed pancytopenia. Since the origin was obscure at first, she was treated with blood transfusion, infusion of platelets, and G-CSF but in vain. When serum level of folic acid was measured, the level was as low as 0.8ng/ml. At this time, pancytopenia due to folic acid deficiency was diagnosed . Percutaneous injection of folic acid everyday provided a rapid improvement.We have to give a multivitamin containing folic acid for patients who require long-term central venous nutrition more then three months like this case. In addition macrocytic anemia had appeared prior to pancytopenia due to folic acid deficiency in this case, and at that time we had to suspect folic acid deficiency. We regret not to do so in this case.