Ectoparasitosis induced severe anemia: a rare cause of severe iron deficiency anemia

Abstract

Abstract Introduction/Objective Ectoparasites generally infest human’s head and body. It is primarily asymptomatic, however, it can cause iron deficiency anemia on rare occasions, even in developed countries. Bird mites can feed on the blood of people who live near infested pigeons or other infested animals. Methods/Case Report We present a 53 years old homeless male who lives in the New York City’s streets. He was brought to the emergency department by EMS due to ataxia and not being able to stand. Upon arrival, he was covered with countless small ectoparasites later identified as bird mites according to an exterminator. Decontamination and stabilization of patient was begun. No active bleeding or sign of trauma was identified. Complete blood count (CBC) was performed and hemoglobin (Hb) of 2.2 g/dL with Hematocrit of 9.2 % was confirmed after repeat on a second sample. Mean corpuscular volume (MCV), red blood cell (RBC) count, reticulocyte percent and red cell distribution width (RDW) was 73.3 fl, 1.26 M/uL, 3.3 % and 19.9 % respectively. Iron study was not performed initially. White blood cell and Platelets count were normal. Hemoglobin electrophoresis was negative for hemoglobinopathies. After initial transfusion of 2 packs of RBC, the Hb was 3.4 g/dL. He started to have seizures and was intubated. He was transferred to ICU. Ferritin level was checked after transfusion and was still markedly decreased (10.9 ng/mL). He received 6 packs of RBC in total (within 10 hours) and Hb reached 8.7 g/dL, and 48 hours after intubation he was extubated. The patient discharged himself against medical advice the next day. Results (if a Case Study enter NA) NA Conclusion With increasing homelessness, physicians should be aware that ectoparasitosis: 1) is a rare cause of iron deficiency anemia, and 2) because of the gradual onset of the anemia, rapid correction with a massive transfusion is neither warranted nor advised.