Thiamine Deficiency in Stem Cell Transplant Patients: A Case Series With an Accompanying Review of the Literature

Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease

“…Patients with allogeneic hematopoietic cell transplant are at high risk for nutritional deficiencies. 5,7 Acute and chronic graft-versus-host disease occurs in an estimated 45% and 70% of such patients, respectively, 5 which can reduce oral intake by affecting the oral mucosa and gastrointestinal tract and can reduce absorption of thiamine from the jejunum. 5 Comorbid renal dysfunction decreases expression of vitamin transporters in the intestine, liver, and heart and also leads to accumulation of oxythiamine, a competitive inhibitor of thiamine.…”

Wernicke’s Encephalopathy in A Young Adult Affected by T Cell Acute Lymphoblastic Leukemia and Ileotiphlytis with Review of the Literature

“…In Table 1 is reported a case series of patients affected by leukemia and with malnourishment of variable origin. Hematopoietic Stem Cell Transplantation increases the risk of this syndrome, particularly in patients experiencing Graft Versus Host Disease involving gastrointestinal tract with diarrhoea and vomit [15,16]. Patients affected by neoplasms are at high risk to develop a thiamine deficiency, because they are often malnourished as a consequence of chemotherapy or disease itself.…”

“…In non-alcoholic patients, the major conditions associated are AIDS, malignancies, hyperemesis gravidarum, surgery (particularly surgical patients who underwent gastric bypass), prolonged total parenteral nutrition and iatrogenic glucose loading in any predisposed patient [13,14]. The recommended dose of thiamine (in an average and healthy adult) is 0.5 mg/1000 kcal consumed or 1.4 mg/die, and, in patients receiving a strict thiamine-free diet, 2-3 weeks are needed to determine a depletion [12,[15][16][17][18]. Furthermore, WE seems to appear more quickly when TPN is administered in hypoalbuminemic patients [13].…”