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Surviving Critical Low Hemoglobin Levels and Pica
Syeda Juwairiyyah Fatima1, Nisha Nepal2, Daniel Ochieta3
1Hematology, University of Vermont, Burlington, USA.
Insights
This case study highlights a woman with severe iron deficiency anemia (IDA) and pica, who recovered without lasting deficits after treatment. Her symptoms included extremely low hemoglobin and unusual cravings, emphasizing the importance of timely intervention.
Area of Science:
- Hematology
- Nutritional Science
- Gastroenterology
Background:
- Iron deficiency anemia (IDA) is a prevalent global health issue.
- Pica, the compulsive consumption of non-food items, is frequently linked to IDA.
- Severe IDA can manifest with significant, though often reversible, clinical symptoms.
Observation:
- A 40-year-old female presented with severe IDA (hemoglobin 1.6 g/dL), critically low iron and ferritin levels, and a history of pica (consuming toilet paper).
- Her symptoms included weight loss, weakness, palpitations, fatigue, dysphagia, vomiting, and severe menorrhagia.
- A significant uterine leiomyoma (fibroid) was identified as a potential contributing factor to her menorrhagia and subsequent anemia.
Findings:
- The patient received blood transfusions and iron supplementation, leading to a hemoglobin increase to 7.3 g/dL.
- Despite the critically low hemoglobin levels, she experienced no lasting neurological or physical deficits.
- Following treatment, her pica behavior ceased, and her overall health improved.
Implications:
- This case underscores the potential for significant recovery from severe IDA with prompt medical intervention.
- It highlights the critical link between iron deficiency, pica, and gynecological conditions like uterine fibroids.
- Early diagnosis and comprehensive management are crucial for addressing IDA and associated conditions, preventing long-term complications.
Abstract:
Iron deficiency is the most common nutritional deficiency. Pica is commonly associated with iron deficiency anemia (IDA). A case of a 40-year-old female who presented with a critical record of low hemoglobin (Hgb) (1.6 g/dL) with severe iron deficiency and pica with no lasting deficits despite such low hemoglobin is discussed in this article. The patient presented to the emergency room with complaints of weight loss, weakness, palpitation, fatigue, dysphagia, and on-and-off vomiting for about a year and severe menorrhagia for about one and a half years. She also has had pica for the past several years where she eats and chews toilet paper. Several of her female family members also have pica. She was found to have critically low hemoglobin of 1.6 g/dL and serum iron of 8 ug/dL and ferritin of less than 1 ng/mL. The patient was treated with six units of packed red blood cells and IV and oral iron supplementation. She was discharged with a hemoglobin of 7.3 g/dL. She was later found to have a 9.6 cm uterine mass that is consistent with leiomyoma (fibroid) in transvaginal ultrasound and is following up with a gynecologist for the definitive management. She did not have lasting deficits from the critically low hemoglobin and has stopped engaging in pica behavior.
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