Pernicious Anemia with Neuropsychiatric Dysfunction in a Patient with Sickle Cell Anemia Treated with Folate Supplementation

doi:10.1056/NEJMoa022639

Volume 348:2204-2207		May 29, 2003		Number 22

Pernicious Anemia with Neuropsychiatric Dysfunction in a Patient with Sickle Cell Anemia Treated with Folate Supplementation

Meekoo Dhar, M.D., Rita Bellevue, M.D., and Ralph Carmel, M.D.

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The administration of folic acid can mask the megaloblasticanemia caused by cobalamin deficiency.¹^,²^,³^,⁴^,⁵ More critically,this masking, although neither complete nor permanent,²^,³^,⁴can permit neurologic dysfunction to develop and sometimes becomeirreversible.¹^,²^,³^,⁴^,⁶ A few authors have proposed that folatemay actually worsen the neurologic dysfunction.³^,⁷

Patients with sickle cell disease are often routinely givenfolate supplementation. The rationale is to prevent the deficiencycaused by the increased folate turnover in chronic hemolyticanemia.⁸ However, clinical folate deficiency rarely occurs inpatients with sickle cell disease, and objective evidence ofa benefit from such supplementation is sparse.⁹ The use of . . . [Full Text of this Article]

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From the Department of Medicine (M.D., R.B., R.C.) and the Comprehensive Sickle Cell/Thalassemia Program (R.B.), New York Methodist Hospital, Brooklyn, N.Y.; and the Department of Medicine, Weill Medical College of Cornell University, New York (R.C.).

Address reprint requests to Dr. Carmel at New York Methodist Hospital, 506 Sixth St., Brooklyn, NY 11215, or at rac9001@nyp.org.

Related Letters:

Folate Supplementation in Sickle Cell Anemia
Hoffer L. J., Carmel R.
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N Engl J Med 2003; 349:813, Aug 21, 2003. Correspondence

This article has been cited by other articles:

Morris, M. S., Jacques, P. F, Rosenberg, I. H, Selhub, J. (2007). Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am. J. Clin. Nutr. 85: 193-200 [Abstract] [Full Text]
Lichtenstein, A. H., Russell, R. M. (2005). Essential Nutrients: Food or Supplements?: Where Should the Emphasis Be?. JAMA 294: 351-358 [Abstract] [Full Text]
Hoffer, L. J., Carmel, R. (2003). Folate Supplementation in Sickle Cell Anemia. NEJM 349: 813-813 [Full Text]

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