Acute folic acid deficiency after bone marrow transplantation

Abstract

After bone marrow transplantation (BMT), megaloblastic bone marrow changes are often observed that can only be partially explained by drug effects. Our goal was to find out whether folic acid deficiency represented an additional factor. The serum folic acid concentrations of 41 patients were determined regularly before and after BMT. A 2nd degree polynomial regression analysis revealed a clear and acute drop in folic acid concentrations within 7-9 days after BMT. In 19 patients the level fell below 3.0 ng/ml, the range of folic acid deficiency. The mean folic acid values without oral administration of folic acid after BMT lay significantly below the mean values with substitution (P less than 0.001). If a case of acute graft versus host disease (GvHD) was more severe than grade I, the mean folic acid levels were significantly lower (P less than 0.01). Patients with megaloblastic bone marrow changes after BMT had significantly lower folic acid values than those without such changes (P less than 0.01). The 18 patients with folic acid deficiency had a significantly higher rate of megaloblasts, binucleate erythropoietic precursors, Howell-Jolly bodies, giant myelocytes, and giant metamyelocytes in bone marrow smears than the remaining 23 patients (P less than 0.05). Folic acid deficiency did not slow down the increase in leukocytes, granulocytes, thrombocytes, or reticulocytes after BMT. There were 8.2%-9.7% hypersegmented neutrophils in the blood (normal 5%) after BMT both with and without folic acid deficiency. Folic acid deficiency after BMT was caused by insufficient intake combined with simultaneous decreased intestinal resorption and increased requirements for the regeneration of bone marrow and intestinal mucosa.

Vitamin requirements during stem cell transplantation: a systematic review

“…Only one study investigated folate status during SCT [32] and found that SCT recipients may be susceptible to folate deficiency, supporting previous findings made by Link et al [37]. It should be noted that the observational study by Link et al [37] was not included in this review due to their inclusion of paediatric participants.…”

“…Only one study investigated folate status during SCT [32] and found that SCT recipients may be susceptible to folate deficiency, supporting previous findings made by Link et al [37]. It should be noted that the observational study by Link et al [37] was not included in this review due to their inclusion of paediatric participants. Although these findings suggest that this population may be at risk of folate deficiency and that supplementation may be indicated, the overall strength of evidence is weak and recommendations surrounding supplementation cannot be made.…”

Antithrombin III Activity Is Not Related to Plasma Homocysteine Concentrations

“…So, high plasma L-homocysteine concentration could play a role in the low antithrombin III activity level. Bone marrow transplantation (BMT) is associated with a decrease of vitamin B,2 absorption and folic acid deficiency [3,4], Deficiencies in vitamin B12, folic acid may result in vary ing degrees of homocysteinemia. So, we have studied the relationship between total plasma L-homocysteine concentrations and inhibitors of blood coagulation levels in 16 patients with malignancies, who received al logeneic or autologous bone marrow grafts.…”

Vitamins Status Following Solid Organ Transplantation

“…[11,12]. Similarly, acute folic acid deficiency was observed after bone marrow transplantation [13]. However, there are reports of normal levels of B-group vitamins after renal transplantation [14].…”