Pica Symptoms Research Articles

The Gut Microbial Lipid Metabolite 14(15)-EpETE Inhibits Substance P Release by Targeting GCG/PKA Signaling to Relieve Cisplatin-Induced Nausea and Vomiting in Rats.

Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect related to activation of substance P (SP). SP activation can result from dysregulation of the gut-brain axis, and also from activation of protein kinase A signaling (PKA) signaling. In this study, we connected these factors in an attempt to unveil the mechanisms underlying CINV and develop new therapeutic strategies. Female rats were injected with cisplatin (Cis) to induce pica. Fecal samples were collected before/after injection, and subjected to lipid metabolomics analysis. In another portion of pica rats, the PKA inhibitor KT5720 was applied to investigate the involvement of PKA signaling in CINV, while fecal microbiota transplantation (FMT) was implemented to verify the therapeutic effect of the lipid metabolite 14(15)-EpETE. Pica symptoms were recorded, followed by ileal histological examination. The targeting relationship between 14(15)-EpETE and glucagon was determined by bioinformatics. SP and glucagon/PKA signaling in rat ileum, serum, and/or brain substantia nigra were detected by immunohistochemistry, enzyme-linked immunosorbent assay, and/or western blot. The results showed a significantly lower level of 14(15)-EpETE in rat feces after Cis injection. KT5720 treatment alleviated Cis-induced pica symptoms, ileal injury, SP content increase in the ileum, serum, and brain substantia nigra, and ileal PKA activation in rats. The ileal level of glucagon was elevated by Cis in rats. FMT exerted an effect similar to that of KT5720 treatment, relieving the Cis-induced changes, including ileal glucagon/PKA activation in rats. Our findings demonstrate that FMT restores 14(15)-EpETE production, which inhibits SP release by targeting GCG/PKA signaling, ultimately mitigating CINV.

Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus

Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.

The Association Between Pica and Iron-Deficiency Anemia: A Scoping Review.

There are many presentations of iron-deficiency anemia associated with pica in adults, but there is a lack of literature summarizing its different presentations. In this scoping review, we sought to identify the various presentations and if treatment of iron-deficiency anemiaresolved the presenting symptoms of pica. This review was conducted by completing the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-Scr) checklist. The following electronic databases were searched for potentially eligible articles: PubMed, ProQuest, and Bielefeld Academic Search Engine (BASE). Study screening procedures were completed with a narrative synthesis. The data is synthesized and interpreted by sifting, charting, and sorting based on organ systems. Twentyarticles met the inclusion criteria and were included in the scoping review. Regardless of other clinical presentations, the identification of pica symptoms allowed treatment for iron deficiency and led to the resolution of all symptoms in all 20 articles. Therefore, it is imperative to map the available evidence to inform clinicians and allow for better patient care.

Prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan: a cross-sectional study

BackgroundPica, the craving for and purposive eating of non-food items, is a common worldwide problem, especially among children and pregnant women. There are few published data on pica among adolescents in sub-Saharan Africa, and no study has been carried- out in Sudan. This study was conducted to determine the prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan.MethodsA school‑based cross‑sectional study was conducted from July to September 2022 among adolescent students (aged 10–19 years) in four public primary and secondary schools in Almatamah locality in north Sudan. Sociodemographic information (age, sex, mother’s education, mother’s occupation, and father’s education) was collected through a questionnaire. Weight and height were measured using a standard procedure, and the body mass index Z-score was computed using the World Health Organization’s reference values. Logistic regression analysis was performed.ResultsOf the 384 enrolled adolescents, 180 (46.9%) were male and 204 (53.1%) were female. Their median (interquartile range) age was 15.1 (13.1‒16.3) years. The prevalence of symptoms of pica was found to be 30.7%, accounting for 118 adolescents. The most common type of pica was geophagia (eating clay and sand; 102 adolescents, 86.4%), followed by pagophagia (eating ice; 14 adolescents, 11.8%) and flour (starch; two adolescents, 1.6%). In the logistic regression analysis, females (adjusted odds ratio = 3.52, 95% confidence interval (CI) = 2.15‒5.78) and a lower level of father’s education (adjusted odds ratio = 2.05, 95% CI = 1.26‒3.34) were associated with symptoms of pica.ConclusionIn Sudan, symptoms of pica are common among adolescents, especially females. Caregivers need to assess pica in adolescents. Further research is needed to develop guidelines, medical training, and practice.

PICA AND THE IRON DEFICIENCY ANAEMIA: A CASE SERIES

Introduction: Pica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, which presented with three different clinical presentations and were found to have iron deficiency anaemia with underlying cause as pica. Case Presentation: We describe three patients who presented with symptoms of pica. The first patient is a 25-year-old man who had obsessive compulsive symptoms associated with daily ingestion of dust,sand and ice. The second patient is a 9-year-old girl who presented with abdominal pain associated with consuming brick remains. Lastly, the third patient, a 19-year-old with mild intellectual disability presented with behavior abnormality and eating cracked cement from walls. All three patients presented with hematological parameters diagnostic for iron deficiency anaemia. Conclusion: Pica has been practiced for centuries without a clear etiology. Clinicians in their practice are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms.Pica symptoms resolved gradually in these patients upon iron supplementation. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to consider pica as a differential diagnosis of iron deficiency.

Demographic, Clinical, and Biochemical Predictors of Pica in a Large Cohort of Blood Donors

Background: Pica is characterized as repeatedly eating or chewing of a non-nutritious substance including, but not limited to ice, clay and dirt, starch, raw pasta, chalk, coal, paint, or paper. Life-threatening conditions, such as gastrointestinal infections and lead poisoning, may occur depending on the substance consumed. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines pica as an eating disorder, but with its strong link to iron deficiency, pica is also characterized as a hematological condition. Blood donation is associated with substantial iron loss. Blood donors often become iron deficient and are susceptible to pica, as well as restless legs syndrome (RLS), an often concurrent condition characterized by an irresistible urge to move legs due to uncomfortable sensations such as tingling, crawling, burn, and pain. The National Heart, Lung, and Blood Institute sponsored REDS-III program prospectively enrolled 13,403 racially diverse blood donors in its RBC Omics study to investigate demographic, clinical, hematological, and biochemical factors associated with pica. Methods: Demographic data, survey questions of pica behaviors and RLS, complete blood count (CBC), and ferritin were collected and analyzed using univariable and multivariable logistic regression analysis. Exclusion criteria were ferritin >800 ng/mL, body mass index (BMI) <17.5, and those with 9 or more donations in the 2 years prior to enrollment who were purposely oversampled for in RBC Omics. Pica was rigorously defined by questionnaire responses: 1) "Yes" to eating ice and, 2) Consumes "8 oz - 24 oz" or "more than 24 oz" of ice and, 3) At frequency of "once a day" or "several times a day". Alternatively, "yes" to eating non-ice substances regardless of amount and frequency was also characterized as pica. Results: The analysis included 11,418 donors with 7,141 Caucasians, 1,581 African Americans, 1,601 Asians, and 1,170 Hispanics. Pica was present in 1.4% (158 out of 11,418) of the study subjects. Asians were less likely to have pica than Caucasians (odds ratio [OR], 0.50 p=0.030), African Americans (OR, 0.41; p=0.014), or Hispanics (OR, 0.33; p=0.002). Females (n=6,044) were more likely to have pica than males (n=5,449; OR, 1.43; p=0.029). Donors ≤30 years were more likely to have pica than donors >30 years (p<0.001). Donors with BMI >30 were more likely to have pica than donors with BMI 17.5 - 25 (p=0.036) and BMI 25-30 (p<0.001). Ferritin was negatively associated with pica (p<0.001). For donors with ferritin <12 ng/mL 2.4% (52/2155), 12-50 ng/mL1.3% (67/5118), and >50 ng/mL 0.9% (39/4145) had pica. CBC values associated with low iron stores were also associated with pica: low hemoglobin (p=0.002), low hematocrit (p=0.014), low mean corpuscular volume (MCV) (p<0.001), and high red blood cell distribution width (RDW) (p<0.001). In multivariable analyses, RLS emerged as the most powerful predictor of pica in our forward stepwise logistic regression model (OR, 4.38; 95% confidence interval, 2.14 - 8.17), p<0.001). Other significant demographic predictors of pica included hormone supplement use (p=0.006) and nulligravida females (p=0.009). Conclusions: Iron deficiency was confirmed as a strong predictor of pica. Consistently, demographic (female), clinical (RLS) and hematological (hemoglobin, MCV, RDW) parameters associated with iron deficiency also were associated with increased risk for pica. However, pica symptoms were also reported by donors with ferritin >50 ng/mL suggesting that non-iron related factors influence pica presentation as well. Pica has a significant prevalence in the blood donor population, and healthcare providers should consider non-iron related factors when diagnosing pica. Disclosures Mast: Novo Nordisk: Honoraria, Research Funding.

Hematobiochemical profiles, mineral concentrations and oxidative stress indicators in beef cattle with pica

Pica, or “depraved appetite”, is defined as ingestion of non-nutritive substances. Many factors influencing pica in animals have been identified , but the etiology is controversial. This study was conducted to evaluate haematological and biochemical parameters, trace element concentrations, the total antioxidant status (TAS), total oxidative status (TOS) and oxidative stress index (OSI) in beef cattle with and without pica. Ten beef cattle with pica (group I) and another ten healthy beef cattle (Group II) were used in the study. Serum TAS and TOS were measured by a colorimetric method. In group I, haemoglobin value and serum iron, copper and selenium concentrations were significantly lower than those of group II (p < .05). Cortisol level and the other biochemical parameters were not statistically different between the groups (p > .05). Compared to the healthy controls mean TAS values were significantly decreased in the group I (p < .05), whereas the TOS and OSI values did not differ statistically between the two groups (p > .05). Parasitological analysis revealed that Trichostrongylidae spp eggs were more common in group I. In conclusion, serum iron, copper and selenium deficiency with decreased antioxidant capacity may cause the symptoms of pica in beef cattle. Prophylactic use of trace mineral supplement containing iron, copper, selenium and antioxidants in beef cattle may be beneficial in preventing deviated appetite and in strengthening the antioxidant defence system.

Pica as a pe rsistent eating disorder associated with iron deficiency anae mia: two case reports

Introduction: Pica is a mysterious condition characterised by patients developing cravings for non- nutritive substances that may escalate into serious medical complications. We present two case reports with a somewhat unusual nature of presentation attributed to iron deficiency. The first is a 25-year old African woman with abnormal uterine bleeding presenting with a fondness for eating clay, cold drinks, and icepacks. The second is 15- year old African girl who presented with bleeding from the nose, habitual smelling of soil, consuming ice packs and chewing rubber bands. Both presented with haematological parameters diagnostic of iron deficiency anaemia.Conclusion: Despite being practised for centuries, the clinical significance of pica symptoms is often not recognised particularly among the younger physicians. Both our patients responded well to managing the primary cause of blood loss and iron supplementation. We are convinced that pica is an important pointer to iron deficiency and clinicians should suspect occult blood loss in a patient presenting with pica symptoms.Keywords: pica, eating disorder, iron deficiency anaemia, case report

Sodium chloride pica causing recurrent nephrolithiasis in a patient with iron deficiency anemia: a case report

BackgroundIron deficiency anemia is a common finding in women of child-bearing age. Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. A high sodium diet increases risk for nephrolithiasis. We describe the case of a 31-year-old woman with recurrent calcium nephrolithiasis and anemia who ate ice chips as well as spoons of salt daily. Treatment of pica may prove effective in preventing recurrent nephrolithiasis.Case presentationA 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. She described a daily pattern of eating continually from a cup of ice chips accompanied by multiple spoons of salt directly out of a salt shaker. These cravings had been present for many years, were bothersome to her, and interfered with her daily life. Laboratory findings revealed hemoglobin of 10.9 g/dL with ferritin of 3 ng/mL. History, physical, and laboratory data were consistent with pica secondary to iron deficiency anemia. She was prescribed orally administered ferrous sulfate 325 mg three times a day with meals. She continues to struggle with the symptoms of pica and orally administered supplementation.ConclusionsIt is important that clinicians consider the possible diagnosis of sodium chloride pica in patients with iron deficiency anemia and recurrent nephrolithiasis. Treatment of anemia and resolution of pica may prove effective in preventing future nephrolithiasis. Specific questioning about pica symptoms in patients with iron deficiency anemia and recurrent nephrolithiasis may be helpful diagnostically and therapeutically.

A Different Kind of Craving: Incidence and Treatment of Pica After Laparoscopic Roux-en-Y Gastric Bypass.

Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported. The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified. Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9±1.9years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0ng/mL (range 2-27). All 16 patients received intravenous iron and pica symptoms resolved. Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.

Qualitative assessment of pica experienced by frequent blood donors

Pica, the compulsive consumption of ice or other nonnutritious substances, is associated with iron deficiency, a common negative consequence of frequent blood donation. Because of this, blood donors, such as those participating in the Strategies to Reduce Iron Deficiency (STRIDE) study, are an ideal population to explore pica and iron deficiency. STRIDE was a 2-year intervention trial to assess the effectiveness of iron supplementation for mitigating iron deficiency in frequent blood donors. Subjects completed baseline and follow-up questionnaires that included questions about pica symptoms. In-depth telephone interviews were conducted with 14 of these subjects reporting pica symptoms and eight presumed controls (casual ice chewers) to gain a deeper understanding of pica symptoms and their impact on daily life and to make a final determination on the presence of pica. Pica was confirmed in five of the 14 subjects reporting symptoms and in two of eight controls. Outcome misclassification based on the questionnaire was attributed to inadequate assessment of several pica symptoms identified during the interview. Comparison of subjects' repeated quantitative iron measurements taken throughout STRIDE with subjects' final adjudicated pica status revealed a positive relationship between development of pica and worsening iron status; the opposite was found in those whose pica symptoms resolved. Continued refinement of pica symptom questions will allow for rapid and accurate detection of pica in frequent blood donors and confirmation of successful treatment with iron supplements.

Incidence of Eosinophilia in Rural Population in North India: A Study at Tertiary Care Hospital

BACKGROUND- Eosinophilia is abnormally high number of eosinophils in the blood. Normally, eosinophils constitute 1 to 6% of the peripheral blood leukocytes, at a count of 350 to 650 per cubic millimeter. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). Eosinophilia may be primary or secondary. The aim of the study was to determine the incidence of eosinophilia and evaluate the patients thoroughly for the cause of eosinophilia. METHOD- The study was conducted in the Pathology department in the medical college and hospital in rural are of Punjab. Complete blood count and peripheral blood film study was done in almost all the patients visiting the hospital. The patients with eosinophilia were segregated and were made to fill the detailed proforma. The information included family history, chief complaints, food habits, disease history and drug history. A thorough general examination and diagnostic work up followed. RESULT- In all 3442 (10.7%) patients visiting the hospital had eosinophilia; out of this 2136 (62%) patients had mild eosinophilia, 1297 (37.7%) had moderate and 9 (0.3%) had severe eosinophilia. 2451(71.2%) patients were males and 991 (28.8%) were females. Age group of patients varied from 3 yrs to 74 yrs. The chief complaints of our patients were related to fever, cough, rashes, breathlessness, wheezing etc. other major group of patients had symptoms of abdominal pain, diarrhea, pallor, pica and loss of appetite. CONCLUSION- Eosinophilia appears to be a common occurrence in the in the rural population around our hospital. The most common etiologies were due to parasitic, protozoal or fungal infestations and infections. Allergy related problem also constituted a significant health problem in the local population. DOI: 10.21276/apalm.2017.1044

Pica – Mind over matter: a case report

The geneses, treatment and outcome of pica remains the subject of much debate. Data regarding pica in adults and in schizophrenia is limited. We present the case of a forty-year old male who presented with subacute intestinal obstruction. Having met the diagnostic criteria for schizophrenia, he subsequently developed symptoms which enabled a diagnosis of pica. Initially the pica symptoms were as a response to the command hallucinations, but later persisted in the absence of hallucinations. Pica can be potentially life-threatening, depending on the substance ingested and the complications that follow, as was the case in this patient. Risperidone, olanzapine or electro convulsive therapy did not have any impact on his symptoms of pica. Clozapine was commenced and a dramatic response was observed, with the pica symptoms completely resolving within 10 days – thus revealing a new facet to the already versatile therapeutic effects of clozapine.

Pica patient, status post gastric bypass, improves with change in medication regimen.

The causes and origins of pica remain unknown and are the source of speculation and heated debate. Bariatric surgery patients are increasingly being observed in eating disorders treatment programs. Often associated with pregnancy, iron deficiency anemia, early development and mental retardation, pica has only recently been noted in post bariatric surgery patients, all of whom presented with pagophagia (eating of ice). Although there is literature detailing the presence of bezoars in gastric bypass patients, the association of pica, bezoars and abnormal eating behavior after bariatric surgery is still not understood completely. We present the case of a patient diagnosed with pica who underwent bariatric surgery due to a specific bezoar causing obstruction, followed by a treatment plan aimed at curbing the impulses. The patient was diagnosed to have a cardboard and paper bezoar causing gastric obstruction, which was removed endoscopically. After incomplete improvement of pica symptoms with treatment including ziprasidone, lorazepam and behavioral therapy, Saphris (asenapine) was introduced resulting in significant and complete resolution.

Restless legs syndrome, pica, and iron status in blood donors.

The association of blood donation-related iron deficiency with pica or restless legs syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS-II Iron Status Evaluation (RISE) study. RISE enrolled 2425 blood donors in a prospective cohort study; 1334 donors provided blood samples to characterize iron status and answered a questionnaire inquiring into symptoms of RLS and pica at a final visit after 15 to 24 months of follow-up. Associations between both conditions and iron status were evaluated. There were 9 and 20% of donors reporting symptoms of probable or probable/possible RLS, respectively. Iron depletion and donation intensity were not predictive of RLS. Pica was reported by 65 donors (5.5%), half of whom reported daily cravings. Prevalence of pica increased with degree of iron depletion in women (2% in iron-replete females, 13% in those with ferritin < 12 ng/mL), but not in men. Probable RLS and pica coexpressed in eight individuals, but no more frequently than expected by chance. RLS and pica have been associated with iron deficiency in nondonor populations. This study indicates a potentially high prevalence of RLS in frequent blood donors but shows no association with iron status or donation intensity. Low iron stores were associated with higher prevalence of pica, but only in females. Furthermore, the results are incompatible with RLS and pica sharing a common pathophysiology.

Combined symptomatology of psychosis, pica syndrome, and hippocampal sclerosis: A case report

Pica is the developmentally and culturally inappropriate eating of nonnutritive substances for at least 1 month. Herein, we present the case of a male patient that suddenly showed behavioral changes including aggressiveness, withdrawal, and perceptional disturbances at the age of 12. About 7 years later, pica symptoms emerged additionally. Neither pharmacotherapy nor electroconvulsive therapy led to success. Magnetic resonance imaging showed bilateral sclerosis of the hippocampus. The therapy with carbamazepine, clozapine, diazepam, and zinc finally improved the symptoms including the pica symptoms.

Sources of Potential Lead Exposure Among Pregnant Women in New Mexico

The objectives of this study were to ascertain the prevalence and potential sources of lead exposure among pregnant women residing in a socially-disadvantaged immigrant community in Albuquerque, New Mexico. Pregnant women (n=140) receiving prenatal care through a community clinic participated in a structured interview and screening to measure their blood lead levels (BLLs). Potential sources of lead exposure were ascertained by the CDC and New Mexico Department of Health questionnaires. Self-reported risk factors were examined as predictors of BLLs using multiple linear regression and partial least squares discriminant analysis. Most patients were Spanish-speaking (88.6%), Latina (95%), foreign-born (87.1%), lacked health insurance (86.4%), and had a high school education or lower (84.3%). While risk factors were prevalent in this population, only three women (2.1%) had BLLs ≥3μg/dL. Results of multivariate analyses demonstrated that pica symptoms in pregnancy, history of elevated BLLs before pregnancy, use of non-commercial pottery, and living in older houses were important predictors of elevated BLLs. Although the prevalence of other risk factors relevant to immigrant communities (i.e., use of traditional/folk remedies and cosmetics, seasonings and food products from Mexico) was high, they were not predictive of elevated BLLs. Clinics providing prenatal care to immigrant Hispanic communities should carefully assess patients' pica symptoms, use of non-commercial pottery, and a history of elevated BLLs. Moreover, additional efforts need to focus on the development of screening questionnaires which better reflect exposures of concern in this population.

Iron Deficiency Anemia Diagnosed in the Private Practice Setting,

Abstract 3186▪▪This icon denotes a clinically relevant abstract Introduction:Iron deficiency anemia (IDA) continues to be a problem in the United States in the 21st Century. Differentiating IDA from anemia of chronic disease (ACD) is important in the clinical practice setting because iron supplementation has been shown to be beneficial for IDA and may deleteriously affect ACD patients. We examined consecutive patients referred for a diagnosis of anemia in a single community-based hematology-oncology practice in the suburbs of a major city over an 8 month period. IDA was found amongst these patients. The common possible causes, symptoms and usual treatment for this subset of patients are reported. Methods:Records of all adult patients referred to the practice with a diagnosis of anemia and were then confirmed to be iron deficiency anemia from March 2010 until November 2010 were reviewed. Chart review analysis was performed to identify differences in gender, causes, symptoms, treatment plans, treatment efficacy, pertinent history and physical findings including laboratory studies - CBC, ferritin, iron/TIBC, reticulocyte count, review of the peripheral blood film, and often but not always, an erythropoietin level. Results:A significant number of patients (n = 130) demonstrated iron deficiency anemia. The vast majority of these patients were female (94%). Most patients were also premenopausal. Four patients were pregnant. The most common cause of iron deficiency anemia was heavy menstrual blood loss associated with the presence of uterine fibroids (67%) followed by, gastric bypass surgery (24%). Interestingly, a subset of patients (12%) had a history of both gastric bypass and heavy menstrual blood loss. Other associated causes found to be linked to IDA were gastrointestinal lesions, such as AV malformations, gastritis, including medication induced gastritis (nonsteroidal anti-inflammatory drugs), hiatal hernia and at least one colon cancer. Subjective symptoms of IDA included tiredness, weakness, exhaustion, brittle nails and hair loss. The finding of pica was quite extensive and often not reported by the patient unless questioned in detail. Pica symptoms included the desire for ice (pagophagia), clay or starch, and also revealed some unusual urges, including eating toilet paper or paper towels, dirt from a patient's rose garden, or the urge to chew gum with the amount exceeding several packages of greater than 10 sticks each per day. One patient reported eating leaves which were stripped from a garden plant. Laboratory studies on these patient subset revealed only 3 had a ferritin level greater than 20 ng/mL (3%). The MCV was less than 80 fl in 111 of the 130 patients. Thrombocytosis (a platelet count of greater than 400,000.103 ml) was an associated finding of IDA and occurred 40 of 130 patients (30%). The platelet count returned to normal in all but one patient post treatment. Conclusion:Iron deficiency is a pervasive problem that is not adequately assessed and treated. Many of our clinic patients developed iron deficiency anemia as a result of surgical intervention, such as gastric bypass surgery. We recommend identifying IDA early to treat patients efficaciously for optimal outcomes. Close attention should be given to key clinical indicators including low MCV and variant forms of pica syndrome which is a valid symptom of iron deficiency. Our experience with administering intravenous iron preparations suggests that patients have improvements in overall well being often within a few days of the first infusion. The pica syndrome resolved in approximately two weeks post the first dose of iron in most patients, even prior to demonstrating any significant improvement in the hemoglobin and hematocrit or the MCV levels. This may imply that iron deficiency affects fundamental enzymes for metabolic processes found in the oral mucosa leading to the PICA.Intravenous iron administration was often used in our practice to bring the hemoglobin and hematocrit to more favorable levels in order to reduce symptoms of iron deficiency or to undergo surgical procedures and childbirth as needed. There was an occasional reaction to intravenous iron that included pruritis, back pain and an unusual swelling in the joints (e.g., knees). We have treated these patients with 100 mg of hydrocortisone intravenously and 25 mg of diphenhydramine intravenously. All reactions usually abated within 30 minutes. We had no fatal reactions to the use of intravenous iron preparations. Disclosures:No relevant conflicts of interest to declare.

The relationship between serum ghrelin levels and hair zinc concentrations in children

Background: Zinc (Zn) plays a central role in the activation of numerous enzyme systems that synthesize and degrade bioactive peptides. Some of these bioactive peptides, also called neuropeptides, are involved in the regulation of food intake.Objective: In this study we aimed to demonstrate the relationship between serum ghrelin and hair Zn concentrations in children. Methods: Prepubertal children brought to our outpatient clinics by their parents because of signs and symptoms of pica, poor appetite, poor growth, and other complaints were included in the study. The children were divided into two groups according to Zn hair concentrations. Group 1 consisted of children with low (< 70 μg/g) hair Zn levels, and group 2 of children with normal ( ≥ 70 μg/g) hair Zn levels. Hair Zn concentrations, serum ghrelin, insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) levels were measured in all children.Results: There were 10 children with low hair Zn levels (group 1) and 15 with normal levels (group 2). Serum IGF-I, IGFBP-3 and ghrelin concentrations of group 1 (103.1 ± 71.8 ng/mL, 1412.8 ± 615.7 ng/mL and 0.96 ± 0.22 ng/mL, respectively) were lower than in group 2(164.9 ± 40.5 ng/mL, 2398.5 ± 295.5 ng/mL and 1.21 ± 0.23 ng/mL, respectively). In univariate analysis, Zn hair concentration was positively associated with serum IGF-I (r=0.424, p=0.035) and IGFBP-3 (r=0.671, p < 0.001) concentrations. The correlation between ghrelin and hair Zn concentrations was not significant (r=0.202, p=0.333).Conclusion: Serum ghrelin concentrations might be affected by low hair Zn concentrations in children.Conflict of interest:None declared.

Pica In Children with Sickle Cell Disease

AbstractAbstract 4807 Background:Pica defined as a compulsive and persistent intake of inedible substances or atypical food combinations at least one month. Association of pica and sickle cell disease (SCD) are poorly documented. Alerted by parents, we decided to verify systematically a) the occurrence of pica in SCD children b) to determine its duration, c) to identify the substances commonly ingested and d) to determine the characteristics among children and adolescents with SCD who reported practicing pica. Methods:SCD patients were seen in the outpatient clinic at the University Children's Hospital Queen Fabiola at Brussels between May 1, 2010 and July 30, 2010 as part of their regular follow-up. Data on sex, age, weight, height, body mass index, sickle cell phenotype, G6PD deficiency as well as biological data such as hematocrit mean corpuscular volume, fetal hemoglobin, plasma iron, zinc, copper, lead levels were recorded from their medical chart. Parents and patients were interviewed for the presence of eating disorders. Children and care givers completed questionnaires assessing symptoms of pica. Patients with acute illness, pregnancy, developmental delay, cognitive impairment or age younger than 3 years were excluded. Student t-test was used for difference in mean values groups by pica presence or absence. Fisher exact test was used to compare categorical variable. Difference in means values were considered statistically significant at p < 0.05. Results:Fifty-Five patients (24 males and 31 females) with a median age of 8. 9 years (6. 7– 11. 3) were evaluated during the study period. Forty-five patients (81.8%) originate from Central Africa, 10.9% (6/55) from West Africa, 1.8 %(1/55) from respectively East Africa, Italy and 3.6% (2/55) have mixed origin. Fifty –two (94.5%) patients are homozygous for Hb S (Hb SS), 3 are SC and 1 has Sβ° thalassemia. Thirty-one patients (56.4%) reported an history of pica and during the study period 29.1% (16/55) reported practicing pica regularly. The mean age of patient with pica was 7. 4 years significantly lower than non-pica patients (p <0.05). Pica prevalence by substances ingested was 16 for amylophagia, 14 for paper and powder, 13 for geophagia, 7 for pencils and textiles, 5 for foam, 4 for soap, and 3 for hair. In 6 cases, there was a familial history of pica in non SS individuals. Except for the fact that the mean hematocrit was lower in pica patients compared to non-pica ones (p < 0.05), all the other biological variables were similar in both groups (p> 0.05) (Table 1). Iron status was identical. Lead overload was absent in the entire cohort. Hemolytic phenotype assessed by LDH was identical in both group and mild zinc deficiency was present in both groups. We did not observe difference due to hydroxyurée intake (p>0.05) Conclusion:In our study, pica appeared to have a very high prevalence in SCD children and adolescents. However, its etiology is still unknown. Except lower age and significant lower hematocrit value in pica patients when compared to non-pica ones, no differences in iron status, zinc deficiency or hematological parameters was found. The general health status evaluated by BMI was identical in both groups and the trend to more boys in the pica group is not significant. Further studies are necessary to establish the etiology of pica and its possible consequences on SCD.Table 1Clinical and biological characteristics of patientsVARIABLESNON PICA (n = 16)PICA (n = 31)p-valueAge (years)9.3 (7.0-12.3)7.4 (5.4-10.7)0.047Sex ratio1.60.80.227BMI (kg/m2)16.4 (14.9-18.9)16.1 (15.3-17.6)0.522Haematocrit (%)27.3 ± 3,624.4 ± 2.70.007MCV (fl)83.7 ± 11.188.5 ± 9.50.157Reticulocytes (x 10≥μl)270.6 (217.5-345.0)334.3 (240.7-419.1)0.288LDH (UI/l)925 (218-345)942.5 (749.5-1104.0)0.756Ferritin (ng/ml)122 (87-188)155 (77-275)0.771Zinc (μg/l)77 (64-89)76 (62-89)0.700Copper (μg/dl)13.5± 26.5140.4 ± 27.70.437Lead (μg/dl)13 (9-20)20.5 (10-25)0.302 Disclosures:No relevant conflicts of interest to declare.