Pica and refractory iron deficiency anaemia: a case report

Christophe Von Garnier,Holger Stünitz,Andreas Zeller,Edouard Battegay,Michael Decker

doi:10.1186/1752-1947-2-324

Abstract

IntroductionIron 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 presentationA 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.ConclusionProlonged 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.

Highlights

Iron deficiency is the most common cause of anaemia worldwide
Pica refers to an ill-defined entity known as a perverted appetite for substances inappropriate for consumption, such as kaolin [1]
Kaolinite is the most important component of kaolin, a white chalky silicate used in the paper-coating industry, in ceramics production and in the pharmaceutical industry

Summary

Introduction

Pica refers to an ill-defined entity known as a perverted appetite for substances inappropriate for consumption, such as kaolin (geophagia) [1]. 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. In 2005, the patient presented with incapacitating fatigue related to severe iron deficiency anaemia (Hb 75 g/litre, MCV 64.6 fl, MCHC 299 g/litre, reticulocytes 13‰, ferritin 6 ng/ml and soluble transferrin receptor 13.4 mg/ml (normal range 2.2 to 4.5 mg/ ml)). 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 strong craving for such stones, of which she would suck on small pieces until these completely dissolved.

Conclusion

Lacey EP

Coltman CA Jr