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To the Editor.—
In a recent report by Celle et al (Eur J Cancer 11:317,1975), rats injected with methotrexate and made anemic by bleeding suffered marked liver damage with diffuse fatty metamorphosis, whereas rats that were not bled suffered no liver toxicity from the same dose of methotrexate despite the development of severe damage to the intestinal mucosa. While the metabolism of methotrexate in the rat may or may not be similar to that in man, this observation behooves those of us using methotrexate for treatment of psoriasis to be particularly cautious in administering this drug to patients with anemia. Repeated measurements of red blood cell as well as white blood cell values should be obtained in patients receiving methotrexate.
Zackheim HS. Methotrexate Toxicity and Anemia. Arch Dermatol. 1976;112(4):559. doi:10.1001/archderm.1976.01630280077035