Elsevier

The Journal of Pediatrics

Volume 156, Issue 2, February 2010, Pages 324-326.e1
The Journal of Pediatrics

Clinical and Laboratory Observation
Parenteral Fish Oil-Associated Burr Cell Anemia

https://doi.org/10.1016/j.jpeds.2009.07.062Get rights and content

We report the development of burr cell anemia in an infant with short bowel syndrome who received parenteral fish oil (Omegaven, Fresenius-Kabi, Graz, Austria) after development of total parenteral nutrition–associated liver disease. Parenteral fish oil was discontinued, and the burr cell anemia disappeared, suggesting that parenteral fish oil might be associated with hemolytic anemia.

Section snippets

Patient Presentation

The patient is a female born at 34 weeks' gestation (birth weight 2210 g) with gastroschisis and jejunal atresia. At surgery on the first day of life, only 40 cm of viable small bowel was present. TPN with intravenous omega-6–based lipid (Intralipid, Fresenius-Kabi, Uppsala, Sweden) was started on the first day of life at a dose of 0.5 g/kg/d. The dose was increased gradually to 3 g/kg/d. During TPN administration, TPN-associated cholestasis developed. At 6 weeks of age, total bilirubin was 2.7

Discussion

The appearance and subsequent resolution of burr cells coinciding with the use and discontinuation of parenteral fish oil, respectively, incriminate this preparation as the cause of these abnormal cells. In vitro and in vivo observations support this hypothesis. Fischler et al8 incubated red blood cells with increasing concentrations of parenteral fish oil and observed red blood cell membrane changes resulting in burr cell formation. In their study, these effects were fully reversible on

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Supported by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research (KL2 RR 024136) (R.C.B). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. The authors declare no conflicts of interest.

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