Clinical and Laboratory ObservationParenteral Fish Oil-Associated Burr Cell 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
References (11)
Intestinal failure-associated liver disease: what do we know today?
Gastroenterology
(2006)- et al.
Reversal of severe parenteral nutrition-associated liver disease in an infant with short bowel syndrome using parenteral fish oil (Omega-3 fatty acids)
J Pediatr Surg
(2008) - et al.
Influence of parenteral fat emulsion Intralipos and citric acid on blood viscosity and erythrocyte morphology in vitro
Colloids Surf B Biointerfaces
(2006) - et al.
Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management
Pediatrics
(2006) - et al.
Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease
Pediatrics
(2008)
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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.