EpistemisPagophagia and pica due to iron deficiency
Specialty: Hematology.
Why it occurs
- Severe iron deficiency anemia (intracellular iron deficiency alters the metabolism of neurotransmitters in the central nervous system, specifically in the dopaminergic pathways that regulate reward and appetite behavior, inducing specific dietary compulsions)
- Pregnancy with functional iron deficiency (due to high fetal demand and expansion of the maternal erythrocyte mass)
- Chronic lead poisoning / Saturnism (directly interferes with heme synthesis and mimics behavioral iron deficiency symptoms)
- Primary psychiatric disorders (obsessive-compulsive disorder or schizophrenia, requiring a diagnosis of exclusion)
- Severe malnutrition or isolated zinc deficiency.
Initial workup
Complete blood count and reticulocyte count (to evaluate the regenerative capacity of the bone marrow); complete iron kinetics (serum iron, serum ferritin, iron binding capacity and transferrin saturation); peripheral blood smear (search for microcytosis, hypochromia and basophilic stippling in the red blood cells, the latter highly characteristic of lead poisoning); determination of lead in peripheral blood (plombemia) in patients with active geophagia or suspected environmental exposure; Simple abdominal x-ray to rule out the presence of radiopaque foreign bodies or signs of intestinal obstruction.
red flags
Manifestations of acute abdominal pain, abdominal distension and absence of gas and stool emission (indicative of mechanical intestinal obstruction or impaction of indigestible foreign bodies such as clay, dirt or hair); clinical signs of intestinal perforation (plank abdomen, positive rebound, fever and systemic tachycardia); altered level of consciousness, extreme irritability, seizures, or peripheral motor neuropathy (suggestive of lead encephalopathy due to consumption of lead-based paint or contaminated soil).
Standard management
- Iron sucrose / Iron dextran — intravenous administration iron; characteristically produces a surprisingly rapid resolution of the compulsive pica symptomatology, often in the first 24 to 48 hours postinfusion, before any significant increase in hemoglobin level is observed.
- Oral ferrous sulfate — conventional replacement treatment; administered at doses of 3 to 6 mg/kg of elemental iron per day divided into three doses in pediatric patients, or 100 to 200 mg of elemental iron per day in adult patients
- Zinc gluconate (specific supplementation if concomitant deficiency of this trace element is noted in the biochemical profile).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Hematology
- Listed causes
- 5
- Treatment options
- 3