[Pancytopenia related to low-dose methotrexate: study of five cases and review of the literature].
OBJECTIVE
The aim of this study is to report personal experience of pancytopenia related to low-dose methotrexate and to review the literature.


METHODS
We included retrospectively all cases of pancytopenia related to low-dose methotrexate (<25 mg/week), followed between January 1997 and December 2006, in the university hospital of Strasbourg, France.


RESULTS
Five women, mean age 75.6 years, were included in the present study. Clinical manifestations included: symptomatic anemia (n=4), infection (n=3) and hemorrhagic manifestations (n=2); one patient had no feature. Mean hemoglobin concentration was 8,8 g/dl; mean white cell and platelet counts were 1,500 /mm(3) and 16,000 /mm(3), respectively. Potential risk factors were identified in all patients: renal failure and low serum albumin levels (n=5), anti-inflammatory drug intake (n=2), folate deficiency (n=4) and cobalamin deficiency (n=1). One patient died of septic and hemorrhagic cerebral complications.


CONCLUSIONS
Pancytopenia related to tow-dose methotrexate is a rare but life-threatening disorder. Search and prevention of potential risk factors are required in all patients; determination of MTHFR genotype may be of several interests as folate supplementation.
Serraj
K
K
Service de médecine interne, diabète et maladies métaboliques, clinique médicale B du CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
Federici
L
L
Maloisel
F
F
Alt
M
M
Andrès
E
E
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D010198:Pancytopenia / Q000139:chemically induced*; D012189:Retrospective Studies
D018501:Antirheumatic Agents; D008727:Methotrexate