Limits...
Pica and refractory iron deficiency anaemia: a case report.

von Garnier C, Stünitz H, Decker M, Battegay E, Zeller A - J Med Case Rep (2008)

Bottom Line: Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed.Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate.In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Outpatient Department, University Hospital Basel, Petersgraben, Basel, Switzerland. christophe.vongarnier@insel.ch

ABSTRACT

Introduction: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed.

Case presentation: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate.

Conclusion: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.

No MeSH data available.


Related in: MedlinePlus

The stone consumed by the patient. Scale in centimetres.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2567333&req=5

Figure 1: The stone consumed by the patient. Scale in centimetres.

Mentions: During a follow-up visit and further explicit questioning about particular eating habits, the patient reluctantly disclosed an almost daily consumption of 'a friable stone' over more than a decade. She reported having developed a particularly strong craving for such stones, of which she would suck on small pieces until these completely dissolved. She had acquired this habit 15 years ago in her home country Cameroon, where consumption of stones is common. To characterise the chalky stone (Figure 1), we contacted our geosciences department. X-ray diffraction measurements confirmed that the substance was essentially composed of kaolinite with traces of quartz (Figure 2). After cessation of kaolinite ingestion, we administered intravenous iron replacement therapy (total of 1000 mg) and the anaemia was corrected within 1 month (Hb 125 g/litre, MCV 79.4 fl, MCHC 333 g/litre, ferritin 13 ng/ml, soluble transferrin receptor 6.6 mg/ml). Tests 3 months later showed a stable blood count and iron studies as follows: Hb 120 g/litre, MCV 83.6 fl, MCHC 346 g/litre, ferritin 11 ng/ml and soluble transferrin receptor 6.0 mg/ml.


Pica and refractory iron deficiency anaemia: a case report.

von Garnier C, Stünitz H, Decker M, Battegay E, Zeller A - J Med Case Rep (2008)

The stone consumed by the patient. Scale in centimetres.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567333&req=5

Figure 1: The stone consumed by the patient. Scale in centimetres.
Mentions: During a follow-up visit and further explicit questioning about particular eating habits, the patient reluctantly disclosed an almost daily consumption of 'a friable stone' over more than a decade. She reported having developed a particularly strong craving for such stones, of which she would suck on small pieces until these completely dissolved. She had acquired this habit 15 years ago in her home country Cameroon, where consumption of stones is common. To characterise the chalky stone (Figure 1), we contacted our geosciences department. X-ray diffraction measurements confirmed that the substance was essentially composed of kaolinite with traces of quartz (Figure 2). After cessation of kaolinite ingestion, we administered intravenous iron replacement therapy (total of 1000 mg) and the anaemia was corrected within 1 month (Hb 125 g/litre, MCV 79.4 fl, MCHC 333 g/litre, ferritin 13 ng/ml, soluble transferrin receptor 6.6 mg/ml). Tests 3 months later showed a stable blood count and iron studies as follows: Hb 120 g/litre, MCV 83.6 fl, MCHC 346 g/litre, ferritin 11 ng/ml and soluble transferrin receptor 6.0 mg/ml.

Bottom Line: Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed.Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate.In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Outpatient Department, University Hospital Basel, Petersgraben, Basel, Switzerland. christophe.vongarnier@insel.ch

ABSTRACT

Introduction: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed.

Case presentation: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate.

Conclusion: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering.

No MeSH data available.


Related in: MedlinePlus