A 19-year-old male patient developed thrombocytopenia and leukopenia due to acute folate deficiency while recovering from a multiple organ failure syndrome. Risk factors for acute folate deficiency are extensive tissue damage due to sepsis, trauma or surgery and acute renal failure requiring renal replacement therapy. The diagnosis is based on bone marrow examination showing marked megaloblastic changes whereas serum folate levels and red cell folate levels are normal. Recognition of this serious complication of critical illness is important because it should be readily prevented by folic acid therapy.
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