levoleucovorin and Anemia--Aplastic

The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.

Topics: Adult; Anemia, Aplastic; Anemia, Sideroblastic; Cordocentesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Leucovorin; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Second; Pregnancy, Multiple; Pyrimethamine; Spiramycin; Sulfadiazine; Toxoplasmosis; Twins

Prolonged exposure to nitrous oxide (N2O) inhibits bone marrow function. The duration of exposure to nitrous oxide necessary to induce these changes and their permanence is unknown. The possible prophylactic effect of prior treatment with folinic acid has not been examined previously. Bone marrow function in patients receiving nitrous oxide was assessed by the deoxyuridine (dU) suppression test. Morphologic changes in the bone marrow were also studied. One group was exposed for under 6 h, the next for between 12 and 24 h and a control group who received nonitrous oxide. The control group and the short exposure group showed no abnormality of bone marrow function. The long exposure group had abnormal dU supression tests and a megaloblastic hematopoiesis. The changes observed in this group resolved 12 h after discontinuance of the anesthetic. The changes observed could be prevented by the preoperative administration of folinic acid. The absence of either morphologic or dU suppression test abnormalities following N2O anesthesia for periods of less than 6 h confirms the safety of this anesthetic for the majority of operations for which it is used. It has been confirmed that prolonged exposure to the gas causes impaired marrow function which is of a temporary nature and may be prevented by the prior administration of folinic acid.

Topics: Anemia, Aplastic; Anesthesia, General; Bone Marrow; Drug Administration Schedule; Hematopoiesis; Humans; Leucovorin; Nitrous Oxide

A 10-year-old girl with aplastic anemia developed seizures and a mild hemiparesis following a bone marrow transplant. Based on serologic evidence and a computed tomography scan, which showed a left parietal lucency with ring enhancement, a diagnosis of toxoplasmosis was considered. A brain biopsy of the lucent area demonstrated the inflammation and necrosis but no organisms were seen. During a six-week course of pyrimethamine, sulfadiazine, and folinic acid therapy there was clinical and neuroradiologic resolution. The short course of therapy as well as the inadvertent substitution of folic acid for folinic acid and trimethoprim-sulfamethoxazole for sulfadiazine resulted in the reappearance of neurologic deficits. Reinstitution of appropriate therapy produced gradual improvement over a nine-month period. Serial computer tomography scans correlated with the clinical course. In the immunologically compromised host CNS toxoplasmosis should be considered in the differential diagnosis of an evolving CNS syndrome. Early detection and prolonged therapy with appropriate drugs can result in a favorable outcome. Computed tomography scanning may be helpful in diagnosis and follow-up.

Topics: Anemia, Aplastic; Bone Marrow; Bone Marrow Transplantation; Calcinosis; Child; Drug Therapy, Combination; Female; Humans; Immunosuppression Therapy; Leucovorin; Neurologic Examination; Pyrimethamine; Sulfadiazine; Thalamus; Tomography, X-Ray Computed; Toxoplasmosis

Topics: Adult; Anemia, Aplastic; Blood Cell Count; Chemical and Drug Induced Liver Injury; Hepatomegaly; Humans; Leucovorin; Liver; Liver Function Tests; Male; Methotrexate; Psoriasis; Splenomegaly; Time Factors

Topics: Aminopterin; Anemia, Aplastic; Biomedical Research; Bone Marrow; Folic Acid; Leucovorin; Pancytopenia