Acute onset of folate deficiency in patients under intensive care.

Four patients with ruptured abdominal aortic aneurysm developed thrombocytopenia and marked megaloblastic changes within 3-10 days of surgery. In 2 patients, direct evidence of folate deficiency within marrow cells was obtained by measuring deoxyuridine suppression in short-term bone marrow cultures. The results suggest that folate deficiency was limited to marrow tissue. Folate deficiency localized to the bone marrow offers an explanation for the extremely rapid onset of thrombocytopenia in these patients. The significance of these findings with regard to folate metabolism is discussed. The importance of recognizing this potentially fatal complication of critical illness is emphasized, because it should be readily prevented by folic acid therapy.