Casserly C M, Stange K C, Chren M M
Department of Medicine, University Hospitals of Cleveland, OH.
J Am Acad Dermatol. 1993 Sep;29(3):477-80. doi: 10.1016/0190-9622(93)70215-f.
Severe megaloblastic anemia with a normal white blood cell and platelet count developed in a patient with psoriasis vulgaris who was receiving long-term, low-dose methotrexate. We believe she had methotrexate-induced folate deficiency anemia with isolated inhibition of the erythrocytic bone marrow line. We review hematologic toxicity from low-dose methotrexate. Physicians caring for patients who receive low-dose methotrexate should be aware that an increase in the erythrocyte mean corpuscular volume may be a useful indicator of folate deficiency and impending toxicity. In addition, folate supplementation may prevent this toxicity (even in patients who do not appear clinically to be folate deficient), although whether methotrexate efficacy diminishes is controversial.
一名寻常型银屑病患者在接受长期小剂量甲氨蝶呤治疗时出现了严重的巨幼细胞贫血，白细胞和血小板计数正常。我们认为她患有甲氨蝶呤诱导的叶酸缺乏性贫血，伴有红细胞骨髓系的孤立抑制。我们回顾了小剂量甲氨蝶呤的血液学毒性。照顾接受小剂量甲氨蝶呤治疗患者的医生应意识到，红细胞平均体积增加可能是叶酸缺乏和即将出现毒性的有用指标。此外，补充叶酸可能预防这种毒性（即使在临床上未表现出叶酸缺乏的患者中），尽管甲氨蝶呤疗效是否会降低存在争议。
