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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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