![]() There was no history of bleeding from the gums, easy bruising or familial bleeding disorders. She reported a history of periodic dizziness with an episode of fainting. On arrival she had profuse bleeding that required etamsylate injection and adrenaline nasal pack. Abdominal ultrasound and stool analysis was done from a collection of a freshly voided stool which was then processed using direct technique (saline and iodine mounts) to identify intestinal parasites about which all the findings were all unremarkable.Ī 16-year-old school girl presented with a history of intermittent epistaxes. A peripheral blood smear showed anisocytosis and pencil-shaped red blood cells. Laboratory investigations: haemoglobin (Hb) was7.8g/dl. Vaginal examination revealed a blood-stained glove. The systemic examination was normal except for a blood pressure of 170/100 and an ejection systolic murmur. Physical examination: a young female who was pale and wasted but fully conscious without jaundice or lower limb oedema. Over the past two months she had progressively increased the habit of eating clay, cold drinks and ice packs: behaviour that was accompanied by dizziness and awareness of her heart beat. She had no lower abdominal pain, per vaginal discharge, dyspareunia, or dysmenorrhea and did not use any contraceptives. The pattern of menstrual bleeding was irregular, prolonged with up to 14 days period between cycles. Case seriesĪ 25-year old female college graduate presented with a six-month history of abnormal uterine bleeding. All patients met criteria for pica under the DSM-5 criteria and they all responded well to treatment. We describe two patients who presented with a habit of ingesting non-nutritive substances which was associated with iron deficiency and blood loss. The recognition of pica is often missed so it is important to have a high index of suspicion when people with known risk factors show suggestive signs and symptoms. Pathogenesis of pica is not well understood through the risk factors are well documented. Most physicians believe pica is an effect rather than a cause of iron deficiency. Pica may present in many forms including the ingestion of ice cubes (pagophagia), clay (geophagia), dried pasta (amylophagia), chalk, paste, starch, kayexalate resin (resinphagia), lemons, tomatoes, cigarette butts, hair, lead, and laundry starch. Īlthough the condition has been documented since antiquity, many sufferers are diagnosed with life- threatening complications such as intestinal obstruction, electrolyte imbalances, renal and liver damage. It has been reported in all ages, and both sexes, and is particularly prevalent among young children, people of low socio - economic status, and pregnant women as well as in cases with micronutrient deficiencies such as iron and zinc. The condition is more frequent in those with autism and intellectual disabilities. Pica may be benign, or it may have life-threatening consequences. The definition is occasionally broadened to include the chewing non-nutritive substances. Pica is typically defined as the persistent ingestion of non-nutritive substances for at least one month at an age when this behaviour is developmentally inappropriate. Keywords: pica, eating disorder, iron deficiency anaemia, case report. 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. Both our patients responded well to managing the primary cause of blood loss and iron supplementation. Both presented with haematological parameters diagnostic of iron deficiency anaemia.Ĭonclusion: Despite being practised for centuries, the clinical significance of pica symptoms is often not recognised particularly among the younger physicians. 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. The first is a 25-year old African woman with abnormal uterine bleeding presenting with a fondness for eating clay, cold drinks, and icepacks. We present two case reports with a somewhat unusual nature of presentation attributed to iron deficiency. ![]() I ntroduction: Pica is a mysterious condition characterised by patients developing cravings for non- nutritive substances that may escalate into serious medical complications. Author(s): Azan A Nyundo (a), Godfrey Mwasada (b), Bonaventura C.T Mpondo (c)Ī Department of Internal Medicine (Division of Psychiatry), School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzaniaī Paradise Specialized Clinic, Mbeya, TanzaniaĬ Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, TanzaniaĬorrespondence: Azan A Nyundo
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