![]() ![]() It is conceivable that the bioavailability of dietary iron was markedly impaired in the presence of abundant calcium sulphate.Īlbeit a rare condition in Central Europe, adult pica should be considered for differential diagnosis of chronic iron deficiency anaemia, particularly if other causes of abnormal iron absorption have been excluded.Extensive research over the last couple of decades has made it obvious that mycotoxins are commonly prevalent in majority of feed ingredients. 5 The type of crayon ingested by our patient consisted of pure calcium sulphate. Pica has recently been identified as a predominant risk factor for anaemia in pregnant women in a large case control study from the Sudan. 4 Some of these materials bind iron in the gastrointestinal tract, worsening the deficiency. Specific nutritional deficiencies of particular trace elements may trigger the unusual cravings for non‐food items. 3 The basis of the bizarre behaviour in pica still remains obscure. 2 Eating of chalk among children and Black pregnant and non‐pregnant women in middle Georgia reflects another example of a socioculturally transmitted form of pica without other apparent psychopathology. Anaemia, dwarfism, and hypogonadism have been related to clay eating among children and women from rural areas in Turkey and Iran. Iron deficiency is one peculiar finding quite commonly associated with pica. Apart from sporadic cases due to a specific underlying psychiatric disorder, pica also features a culture bound syndrome worldwide. 1 Pica is most common in those with developmental disabilities, including autism and mental retardation, and in children. Pica comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite, and implies a qualitative eating disorder defined by oral ingestion of non‐food items for at least one month. This exceptional case of severe iron deficiency anaemia related to long term ingestion of large amounts of purchasable crayons clearly meets the diagnostic criteria of adult pica. ![]() Insert: type of purchasable crayon ingested. Erythrocytes are smaller in size (microcytosis) and show expansion of their central area of pallor, thereby appearing to have only a thin rim of haemoglobin (hypochromia). Starting treatment with an oral iron preparation resulted in reticulocytosis with a peak of 7.8% after 10 days.įigure 1 Red cell smear at the time of admission, with typical features of severe iron deficiency. Three days after cessation, oral iron absorption tests were normal. She had such a craving for clean white crayons that she had increased her intake to 20 packages per month (fig 1 1). Exploring her food patterns she confessed to regular eating of crayons for more than nine years to compensate for a sulky taste. Gynaecological examination excluded uterine bleeding. In fact, the guaiac smear test was negative and endoscopies of the gastrointestinal tract revealed no abnormalities. Erythrocyte count was normal (4.14×10 12/l), indicating enduring iron deficient erythropoiesis rather than bleeding. According to this, serum iron was below 5 µg/l, serum transferrin was elevated to 3.97 g/l and less than 10% saturated, and serum ferritin concentration was 3 mg/l. Blood smear showed a strikingly microcytotic hypochromic red blood cell morphology (mean corpuscular volume 56 fl, mean corpuscular haemoglobin 15.5 pg/cell, mean cell haemoglobin concentration 27.5 g/dl) (fig 1 1). Pulse frequency and blood pressure were normal. Despite the severity of the anaemia she appeared well. On physical examination she appeared to have a normal nutritional condition but her skin was pale and she had brittle nails. ![]() She complained of fatigue and occasionally frontal headaches. We recently observed a patient with severe iron deficient anaemia mimicking impaired iron absorption in the absence of gastrointestinal pathology.Ī 47 year old women was admitted to hospital in 2005 because a haemoglobin level of 6.4 g/dl had attracted attention when she was donating blood. Abnormal iron absorption is a well recognised feature of subtle non‐bleeding gastrointestinal conditions, such as coeliac disease or atrophic body gastritis, without otherwise gastrointestinal symptoms. ![]()
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