Finally, there is a higher prevalence of pica (as a marker of impaired mental development) among patients with SCD who have a complication of stroke when compared with the general population with SCD. Second, pica is an indicator of disease severity, reflected by the number of hospitalizations and days spent in the hospital. First, pica occurs in children with SCD at an unusually high prevalence and at an older age than has been previously described in other populations. To examine the factors associated with this unusually high prevalence of pica in SCD, we reviewed all routine visits (480 patients) during a 15-month interval (March 1, 1998, through June 30, 1999) and tested the following 3 hypotheses. In a previous questionnaire study from our institution, 170 patients with SCD were observed and a significant proportion (33.5%) of the patients reported having pica. 7, 8 Pica has been specifically described in children with sickle cell disease (SCD). 6 Although a causal effect has not been determined, several other studies have also reported improvement of pica with zinc supplementation. 5 Patients exhibiting pica have been shown to have decreased iron and zinc absorption, compared with control subjects. Subsequent zinc supplementation resulted in elimination of pica. A study of 213 preschool children with low zinc levels, assessed by means of hair sampling, showed pica to be a frequent presenting complaint. 4 Zinc deficiency has also been considered as a cause for pica. In this group, the average hemoglobin (Hb) and ferritin levels were below the reference range. Among the many groups experiencing pica are pregnant women in 1 study, 56% of the women surveyed reported regular ingestion of dirt (geophagia). Pica has been classically associated with iron deficiency and lead encephalopathy. Although the etiology is poorly understood, associations have been described with iron deficiency, zinc deficiency, mental and developmental delay, psychosocial problems, and family history of pica. This unusual behavior may lead to a variety of complications, including abdominal complaints, poisoning, electrolyte imbalance, and dental injury. PICA IS THE compulsive ingestion of particular food items or nonnutritive substances. The association between pica and low body weight suggests a nutritional effect on its prevalence. It is unclear whether pica is a specific marker of disease severity, because our review did not show a relationship to increased number and duration of hospitalizations. Within age groups, patients with pica weighed significantly less.Ĭonclusions Pica appeared to have an unusually high prevalence in patients with sickle cell disease and a correlation with lower Hb levels.
Overall, the mean age of patients with pica was significantly lower however, the prevalence was 23.3% (27/116) among those aged 10.0 to 14.9 years and 14.8% (8/54) among those aged 15.0 to 19.0 years. Within genotype, mean Hb levels were significantly lower and reticulocyte counts were significantly higher in the patients with pica. There was a significantly higher prevalence of pica among patients homozygous for Hb S (Hb SS, sickle cell anemia) compared with the combined group of double heterozygous patients with Hb SC, Hb SD, and Hb Sβ thallasemia (Sβ +or Sβ 0) (35.6% vs 25.5% P =. Ingested items included paper, foam, and powders. Results Of 395 study patients, 134 (33.9%) reported pica. Main Outcome Measures Sex, age, weight, height, Tanner stage, complete blood cell count, sickle cell genotype, pica history, and levels of iron, zinc, lead, and fetal hemoglobin (Hb). Patients were excluded for history of stroke, long-term transfusions, pregnancy, acute illness, or age younger than 3 years. Patients The medical records of all 480 patients who visited the center from March 1, 1998, to June 30, 1999, were reviewed. Setting An urban, ambulatory care, interdisciplinary center. Objective To determine the prevalence of pica and its characteristics among children with sickle cell disease.ĭesign Retrospective, observational study.