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Akut Lenfoblastik Lösemili Çocuklarda İdame Tedavisinin Nadir Bir Komplikasyonu: Folik Asit Eksikliği

Year 2020, Volume: 5 Issue: 4, 701 - 704, 30.12.2020
https://doi.org/10.26453/otjhs.742731

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.

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

Year 2020, Volume: 5 Issue: 4, 701 - 704, 30.12.2020
https://doi.org/10.26453/otjhs.742731

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.

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

Mustafa Büyükavcı 0000-0002-9054-3134

Olena Erkun 0000-0003-3067-3794

Ayşegül Pala 0000-0001-9056-144X

Mehmet Fatih Orhan 0000-0001-8081-6760

Publication Date December 30, 2020
Submission Date May 27, 2020
Acceptance Date October 24, 2020
Published in Issue Year 2020 Volume: 5 Issue: 4

Cite

AMA Büyükavcı M, Erkun O, Pala A, Orhan MF. Akut Lenfoblastik Lösemili Çocuklarda İdame Tedavisinin Nadir Bir Komplikasyonu: Folik Asit Eksikliği. OTJHS. December 2020;5(4):701-704. doi:10.26453/otjhs.742731

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