Saliphagia: a new form of an
old symptom
Alejandro Lazo-Langner,* Eduardo
Reynoso-Gómez°
*Department of Hematology-Oncology, Instituto Nacional de
Ciencias Médicas y Nutrición Salvador
Zubirán, Mexico City;°Department of Hematology,
Hospital Español de México, Sociedad de Beneficencia
Española de México, Mexico City, Mexico.
Correspondence: Dr. Alejandro Lazo-Langner, Departamento de
Hematología y Oncología, Instituto Nacional de
Ciencias Médicas y Nutrición Salvador
Zubirán. Vasco de Quiroga 15, Tlalpan 14000, México,
D.F., México. Tel. international +525.5731200 ext. 2700,
2220. Fax: international +525. 6556062. E-mail: alazo@medscape.com
Abstract
Iron deficiency is the leading cause of anemia worldwide. Pica is defined as the ingestion of non-nutritive substances and is a symptom whose presence almost always points to a diagnosis of iron deficiency. Pica is frequently overlooked due to its pleomorphism and a careful interview is needed to discover the many uncommon forms of this symptom. We report the case of a 35 year-old female that presented with an uncommon form of pica characterized by heavy aspirin and Coca-Cola ingestion.
Text
Iron deficiency is the most
common cause of anemia worldwide and it is more prevalent in
developing countries.1 Many signs and symptoms are
related to it, being pica one of the most intriguing and yet
unexplained. One third to one half of patients with
iron-deficiency anemia present with some form of pica2
(and personal data). The most common forms of this symptom
are probably pagophagia and geophagia, but there are many less
common ones and it is a challenge for the clinician to unveil
them. Although its pathophysiology has not been elucidated, it is
known that it is related to iron deficiency per se, rather than to
anemia. The discovery of pica is gratifying for the physician and
is very helpful in clinical practice because its presence almost
always points to a diagnosis of iron deficiency. We report an
unusual case of iron deficiency anemia and polypica characterized
by heavy aspirin and Coca-Cola ingestion.
A thirty-five year-old female sought medical attention because of
an 8 year history of heavy menstrual blood losses. A careful
interview pointed out the presence of a compulsive craving for
salt, Coca-Cola and aspirin with a mean intake of forty 500-mg
tablets per week that had been present for 72 months prior to
medical attention. On physical examination she was found pale and
tachycardic. Baseline CBC showed hemoglobin 64 g/L, hematocrit
0.24, MCV 56.2 fL and MHC 15 pg. Total serum iron was 0.89 mmol/L,
TIBC was 63 m mol/L, transferrin saturation was 1.4% and serum
ferritin level was 1.84 mg/L. A diagnosis of iron-deficiency
anemia was made and the patient was given a total-dose intravenous
iron-dextran infusion. The infusion was well tolerated and after 8
weeks hemoglobin raised to 143 g/L and hematocrit to 0.45 with
normalization of MCV and MHC. It is noteworthy that 5 days after
iron-dextran infusion all the cravings ceased.
Many forms of pica has been described2 and due to its
pleomorphism many times the symptom is not discovered. To our
knowledge, there are no reports regarding Coca-Cola or aspirin
intake as one of them. It is a well known fact that pica symptoms
cease after iron replacement, such as happened in our patient.
Although gynecological blood losses were the initial cause, it is
very likely that such a heavy aspirin intake also contributed to
blood loss presumably aggravating the menstrual losses and/or
conditioning gastrointestinal bleeding. Total-dose intravenous
iron-dextran infusion is a cheap, safe and effective method to
replace iron that can be used as first-line therapy in patients in
whom oral iron administration could exacerbate the symptoms of the
underlying disorder (eg. Acid-peptic disorder) in those with
intolerance to oral iron salts or impaired intestinal absorption
or as a way to avoid blood transfusion in patients who will
undergo elective surgery. Finally, we emphasize the importance of
a thorough clinical history in the uncovering of this sometimes
elusive symptom and we propose the term saliphagia (from
latin salix, willow and greek phagein, to eat) to
name the pica for aspirin.
