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Severe pancytopenia developed in two infants with isovaleric acidemia. Previous reports indicate these hematologic abnormalities are a leading cause of death in affected infants. Our findings suggest that the pancytopenia may be due to arrested maturation of hematopoietic precursors. Prompt transfusion of appropriate blood components prevented complications due to the hematologic abnormalities.

Aminoacidopathies are rare metabolic defects that frequently present shortly after birth or in early infancy with vomiting, dehydration, ketoacidosis, and a peculiar body odor. If not recognized early, these can result in developmental retardation and/or death. A case of isovalericacidemia is reported to emphasize the importance of metabolic screening when an infant presents with the above-mentioned symptoms along with an anion gap greater than 20 mEq/liter. In our patient, a metabolic disorder was suggested by the clinical presentation and was confirmed by measuring elevated levels of biproducts. The infant was given a low-leucine diet and has developed normally since then.