Pica in Iron Deficiency: 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, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported.
Case presentation: We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia.
Conclusion: Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians 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 abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. 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 search for occult blood loss with secondary iron deficiency.
Pica is an unusual craving for and ingestion of either edible or inedible substances. The condition has been described in medical journals for centuries. One of the first cases of pica was noted in 6th century AD and was observed in a pregnant woman. Since then, many cases of pica have been reported where patients have acknowledged ingesting ice cubes (pagophagia), clay (geophagia), dried pasta (amylophagia), chalk, starch, paste, Kayexalate resin (resinphagia), tomatoes, lemons, cigarette butts, hair, lead, and laundry starch (for example, Argo out of the box). Although pica is most prominent in individuals with developmental disabilities, it has been observed in men and women of all ages and ethnicity, but is more prevalent among the lower socioeconomic classes. Worldwide, 25% to 33% of all pica cases involve small children, 20% are pregnant women, and 10% to 15% are individuals with learning disabilities. A small percentage of patients have iron deficiency anemia.
Pica poses significant health risks that often require medical interventions. These patients are susceptible to electrolyte and metabolic disorders, lead and mercury poisoning, hypokalemia (from resinphagia), parasitic infections, tooth wear, intestinal obstruction, and various problems of the gastrointestinal tract. The exact etiology of pica remains unclear, but it is significantly associated with iron deficiency anemia. When associated with iron deficiency, most physicians believe that pica is an effect rather than a cause.
Surprisingly, we found that the majority of primary care physicians are unaware of pica symptoms. Over a period of 30 years, our group has evaluated a monthly average of one to two patients with iron deficiency. We have also noted that although the ingestion of excessive amounts of ice (pagophagia) is an unusual symptom, its presence has invariably been associated with documented cases of iron deficiency anemia.
Here we present three patients who demonstrated subtle changes in pica associated with iron deficiency. We believe that this was due to advances in technology and changing cultural customs. Each patient fully meets the criteria for pica from Diagnostic and Statistical Manual of Mental Disorders and suffered from severe iron deficiency anemia.
Abstract and Introduction
Abstract
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, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported.
Case presentation: We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia.
Conclusion: Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians 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 abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. 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 search for occult blood loss with secondary iron deficiency.
Introduction
Pica is an unusual craving for and ingestion of either edible or inedible substances. The condition has been described in medical journals for centuries. One of the first cases of pica was noted in 6th century AD and was observed in a pregnant woman. Since then, many cases of pica have been reported where patients have acknowledged ingesting ice cubes (pagophagia), clay (geophagia), dried pasta (amylophagia), chalk, starch, paste, Kayexalate resin (resinphagia), tomatoes, lemons, cigarette butts, hair, lead, and laundry starch (for example, Argo out of the box). Although pica is most prominent in individuals with developmental disabilities, it has been observed in men and women of all ages and ethnicity, but is more prevalent among the lower socioeconomic classes. Worldwide, 25% to 33% of all pica cases involve small children, 20% are pregnant women, and 10% to 15% are individuals with learning disabilities. A small percentage of patients have iron deficiency anemia.
Pica poses significant health risks that often require medical interventions. These patients are susceptible to electrolyte and metabolic disorders, lead and mercury poisoning, hypokalemia (from resinphagia), parasitic infections, tooth wear, intestinal obstruction, and various problems of the gastrointestinal tract. The exact etiology of pica remains unclear, but it is significantly associated with iron deficiency anemia. When associated with iron deficiency, most physicians believe that pica is an effect rather than a cause.
Surprisingly, we found that the majority of primary care physicians are unaware of pica symptoms. Over a period of 30 years, our group has evaluated a monthly average of one to two patients with iron deficiency. We have also noted that although the ingestion of excessive amounts of ice (pagophagia) is an unusual symptom, its presence has invariably been associated with documented cases of iron deficiency anemia.
Here we present three patients who demonstrated subtle changes in pica associated with iron deficiency. We believe that this was due to advances in technology and changing cultural customs. Each patient fully meets the criteria for pica from Diagnostic and Statistical Manual of Mental Disorders and suffered from severe iron deficiency anemia.
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