Sulfasalazine and Folate Deficiency
- Enrique Spindel, MD
Since this article does not have an abstract, we have provided the first 150 words of the full text.
Excerpt
To the Editor.— The letter entitled "Sulfasalazine and Folate Deficiency" (1983;249:729) describes an interesting case of ulcerative colitis and severe anemia with associated direct Coombs' test positivity and folate deficiency. The conclusions of the author about the relationship between sulfasalazine and folate deficiency may be misleading and have thus prompted this letter.
Although sulfasalazine inhibits folate absorption, anemia caused by folate deficiency is not common in patients with ulcerative colitis and adequate dietary intake of folate. Macrocytic anemia caused by folate deficiency has been documented to occur in only 2.5% of patients with ulcerative colitis.1 Furthermore, folate deficiency in this small number of patients may have other causes such as celiac disease, nutritional deficiencies, and hemolysis.1
Folate deficiency can occur because of chronic hemolysis of any cause and may have occurred in the patient described by Dr Goldberg. In addition, the fact that the patient suffered from ulcerative
