BMJ Case Reports 2010; doi:10.1136/bcr.03.2010.2851
  • Unusual association of diseases/symptoms

Severe folate-deficiency pancytopenia

  1. Simon Weston-Smith2
  1. 1Department of Medicine, East Sussex Hospital NHS Trust, East Sussex, UK
  2. 2Department of Haematology, East Sussex Hospital NHS Trust, East Sussex, UK
  1. Correspondence to Viktoriya Clarke, drvclarke{at}


Folate-deficiency anaemia occurs in about 4 per 100 000 people, although severe cases causing moderate pancytopenia are rarer. We present the case of a significant folate deficiency in a 50-year-old alcoholic with a background of mild liver impairment and recurrent nasal and rectal bleeding. Her blood tests showed profound macrocytic anaemia with haemoglobin 2.6 g/dl, leucopoenia with white cell count 3.2 × 109/litre and thrombocytopenia with platelets 17 × 109/litre. Serum folate was 0.8 ng/ml (normal 2.5–13.5 ng/ml) confirming severe deficiency.

Despite these life-threatening results, the patient was stable, alert and was keen to avoid admission. Medical management of the anaemia included slow transfusion of red cells and one unit of platelets in view of haemorrhagic symptoms, two injections of vitamin B12 while awaiting assays and oral folic acid. A rapid improvement in the leucopoenia and thrombocytopenia resulted and no additional complications were encountered.


  • Competing interests None.

  • Patient consent Obtained.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article