Case Report
Akut Lenfoblastik Lösemili Çocuklarda İdame Tedavisinin Nadir Bir Komplikasyonu: Folik Asit Eksikliği
Abstract
Vitamin B12 (cobalamin) and folic acid play a crucial role in DNA synthesis, cell division and proliferation. Their deficiency may cause serious disorders of hematopoietic, gastrointestinal and neurologic system. A 14-year-old girl, undergoing maintenance chemotherapy (methotrexate, 6-mercaptopurine) for acute lymphoblastic leukemia (ALL), presented with the complaints of pallor and nose bleeding. At admission, white blood cells (WBC) was 2230/mm3, hemoglobin 6.2 gr/dL, mean corpuscular volume (MCV) 122 fL and thrombocytes 26700/mm3. Peripheral blood smear revealed hypersegmented neutrophils, macrocytosis, anisocytosis, rare normoblasts and 4-5 platelet per field. Bone marrow aspiration and biopsy did not confirm the pre-diagnoses of relapsed ALL, hemophagocytic lymphohistiocytosis (HLH) and myelodysplastic syndrome (MDS). Vitamin B12 and folic acid were prescribed after obtaining the results of vitamin B12 (587 pg/mL), folic acid (1.3 ng/mL) and homocystein (21 µmol/L). Folic acid deficiency must be kept in mind in childrenwith ALL receiving maintenance therapy. Serum cobalamin and folic acid levels must be checked in case of unexplained pancytopenia.
Keywords
References
- 1U.S. National Institutes of Health. Vitamin B12. 2020.https://ods.od.nih.gov/factsheets/VitaminB12HealthProfessional/. Erişim tarihi 29 Haziran 2020.
- Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood. 2017;129(19):2603-2611.
- Qiu A, Jansen M, Sakaris A, et al. Identification of an Intestinal Folate Transporter and the Molecular Basis for Hereditary Folate Malabsorption. Cell. 2006;127(5):917-928.
- Roy Moulik N, Kumar A, Agrawal S, Mahdi AA. Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic leukemia-Implications and outcome. Pediatr Blood Cancer. 2018;65(1). doi:10.1002/pbc.26730
- Socha DS, DeSouza SI, Flagg A, Sekeres M, Rogers HJ. Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleve Clin J Med. 2020;87(3):153-164.
- Devalia V, Hamilton MS, Molloy AM. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
- Lanzkowsky P. Chapter 7 -Megaloblastic Anemia. In: Lanzkowsky P, Lipton JM, Fish JD, Editors Lanzkowsky's Manual of Pediatric Hematology and Oncology. 6th Edition. Academic Press: San Diego. 2016:32-41.
- Robien K. Folate during antifolate chemotherapy: what we know... and do not know. Nutr Clin Pract. 2005;20(4):411-422.
- Schrøder H, Clausen N, Ostergård E, Pressler T. Folic acid supplements in vitamin tablets: a determinant of hematological drug tolerance in maintenance therapy of childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol. 1986;3(3):241-247.
- Kennedy DA, Grupp S, Greenberg M, Koren G. Folate fortification and survival ofchildren with acute lymphoblastic leukemia. Pediatr Drugs. 2011;1;13(3):193-196.
A Rare Complication of Maintenance Therapy in Children with Acute Lymphoblastic Leukemia: Folic Acid Deficiency
Abstract
Vitamin B12 (cobalamin) and folic acid play a crucial role in DNA synthesis, cell division and proliferation. Their deficiency may cause serious disorders of hematopoietic, gastrointestinal and neurologic system. A 14-year-old girl, undergoing maintenance chemotherapy (methotrexate, 6-mercaptopurine) for acute lymphoblastic leukemia (ALL), presented with the complaints of pallor and nose bleeding. At admission, white blood cells (WBC) was 2230/mm3, hemoglobin 6.2 gr/dL, mean corpuscular volume (MCV) 122 fL and thrombocytes 26700/mm3. Peripheral blood smear revealed hypersegmented neutrophils, macrocytosis, anisocytosis, rare normoblasts and 4-5 platelet per field. Bone marrow aspiration and biopsy did not confirm the pre-diagnoses of relapsed ALL, hemophagocytic lymphohistiocytosis (HLH) and myelodysplastic syndrome (MDS). Vitamin B12 and folic acid were prescribed after obtaining the results of vitamin B12 (587 pg/mL), folic acid (1.3 ng/mL) and homocystein (21 µmol/L). Folic acid deficiency must be kept in mind in childrenwith ALL receiving maintenance therapy. Serum cobalamin and folic acid levels must be checked in case of unexplained pancytopenia.
Keywords
References
- 1U.S. National Institutes of Health. Vitamin B12. 2020.https://ods.od.nih.gov/factsheets/VitaminB12HealthProfessional/. Erişim tarihi 29 Haziran 2020.
- Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood. 2017;129(19):2603-2611.
- Qiu A, Jansen M, Sakaris A, et al. Identification of an Intestinal Folate Transporter and the Molecular Basis for Hereditary Folate Malabsorption. Cell. 2006;127(5):917-928.
- Roy Moulik N, Kumar A, Agrawal S, Mahdi AA. Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic leukemia-Implications and outcome. Pediatr Blood Cancer. 2018;65(1). doi:10.1002/pbc.26730
- Socha DS, DeSouza SI, Flagg A, Sekeres M, Rogers HJ. Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleve Clin J Med. 2020;87(3):153-164.
- Devalia V, Hamilton MS, Molloy AM. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
- Lanzkowsky P. Chapter 7 -Megaloblastic Anemia. In: Lanzkowsky P, Lipton JM, Fish JD, Editors Lanzkowsky's Manual of Pediatric Hematology and Oncology. 6th Edition. Academic Press: San Diego. 2016:32-41.
- Robien K. Folate during antifolate chemotherapy: what we know... and do not know. Nutr Clin Pract. 2005;20(4):411-422.
- Schrøder H, Clausen N, Ostergård E, Pressler T. Folic acid supplements in vitamin tablets: a determinant of hematological drug tolerance in maintenance therapy of childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol. 1986;3(3):241-247.
- Kennedy DA, Grupp S, Greenberg M, Koren G. Folate fortification and survival ofchildren with acute lymphoblastic leukemia. Pediatr Drugs. 2011;1;13(3):193-196.
There are 10 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case report |
| Authors | |
| Publication Date | December 30, 2020 |
| Submission Date | May 27, 2020 |
| Acceptance Date | October 24, 2020 |
| Published in Issue | Year 2020 Volume: 5 Issue: 4 |
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