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Characterization of Pica Prevalence Among Patients With Sickle Cell Disease
Natalia S. Ivascu, MD;
Sharada Sarnaik, MD;
Jocelyn McCrae, PhD;
Wanda Whitten-Shurney, MD;
Ronald Thomas, PhD;
Sandy Bond, RN
Arch Pediatr Adolesc Med. 2001;155:1243-1247.
Objective To determine the prevalence of pica and its characteristics among children
with sickle cell disease.
Design Retrospective, observational study.
Setting An urban, ambulatory care, interdisciplinary center.
Patients The medical records of all 480 patients who visited the center from
March 1, 1998, to June 30, 1999, were reviewed. Patients were excluded for
history of stroke, long-term transfusions, pregnancy, acute illness, or age
younger than 3 years.
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).
Results Of 395 study patients, 134 (33.9%) reported pica. Ingested items included
paper, foam, and powders. 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 Sß thallasemia (Sß+or Sß0) (35.6%
vs 25.5%; P = .03). Within genotype, mean Hb levels
were significantly lower and reticulocyte counts were significantly higher
in the patients with pica. 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 age groups, patients with pica weighed significantly less.
Conclusions Pica appeared to have an unusually high prevalence in patients with
sickle cell disease and a correlation with lower Hb levels. 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.
The association between pica and low body weight suggests a nutritional effect
on its prevalence.
From the Sickle Cell Center (Drs Ivascu, Sarnaik, McCrae, and Whitten-Shurney
and Ms Bond) and the Child Research Center (Dr Thomas), Department of Pediatrics,
Children's Hospital of Michigan and Wayne State School of Medicine, Detroit.
Corresponding author: Sharada Sarnaik, MD, Sickle Cell Center, Children's
Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201 (e-mail: ssarnaik{at}med.wayne.edu).
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ABSTRACT
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