Салифагия при железодефицитной анемии

[Dr.Vad]

Салифагия (поедание аспирина с Кока-Колой)- необычный вариант пики при железодефицитной анемии:

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 pica. 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 35 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 described 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.

Haematologica. 2001 Oct;86(10):E29