Thiamine Deficiency Following Umbilical Cord Blood Transplant

Abstract

A case of Wernicke encephalopathy (WE) in the setting of umbilical cord blood transplant is reported. The patient, originally diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia, proceeded to an umbilical cord blood transplant. He presented with altered mental status 149 days following transplant. Prompt magnetic resonance imaging, baseline thiamine level, and immediate intravenous replacement allowed for recovery of most symptoms. Accompanying this case is a review of the known cases of WE in hematopoietic cell transplants and their causative factors. This is the first known adult case of WE independent of parenteral nutrition use in the setting of umbilical cord transplant.

Lactic Acidosis as Presenting Symptom of Thiamine Deficiency in Children with Hematologic Malignancy

“…The presence of graft versus host disease of the intestines may also cause thiamine deficiency through malabsorption and vomiting. 1,6 In hematological malignancies, methotrexate may compete with the thiamine transport systems by reducing the availability of thiamine, which may cause lactic acidosis by the same mechanism as that described in case of thiamine deficiency. 7 The sudden onset of the symptoms and the short interval between thiamine drop-off and the clinical manifestations are explained by the lack of a storage mechanism for thiamine, which renders its supply dependent upon regular daily intake via nutrition.…”

A Rare Complication Developing After Hematopoietic Stem Cell Transplantation: Wernicke’s Encephalopathy

“…Thiamine is a water-soluble vitamin also known as vitamin B1 [ 1 ]. Thiamine deficiency can present as a central nervous system (CNS) disorder known as Wernicke’s encephalopathy (WE), which classically manifests as confusion, ataxia, and ophthalmoplegia [ 1 , 2 ].…”

“…Thiamine is a water-soluble vitamin also known as vitamin B1 [ 1 ]. Thiamine deficiency can present as a central nervous system (CNS) disorder known as Wernicke’s encephalopathy (WE), which classically manifests as confusion, ataxia, and ophthalmoplegia [ 1 , 2 ]. The disease is most frequently associated with chronic alcoholism, yet it can also occur in relation to other forms of malnutrition or malabsorption such as prolonged total parenteral nutrition (TPN), total gastrectomy, gastrojejunostomy, severe anorexia, or hyperemesis gravidarum [ 3 ].…”