Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. What are the two most common causes of pica? Paper has little to no nutritional value and is indigestible by the human body. Is it OK to eat tissue paper?Įating small amounts of paper is generally harmless, but it is better to avoid it, especially if it has ink on it. People who suffer from this eating disorder usually consume substances like paper, pencils, tree barks or other items made of wood. Xylophagia is a condition involving the consumption of paper and form of eating disorder known as pica. Our hope in naming this relatively unexplored symptom associated with IDA will encourage additional clinicians to share their experience and guide future investigation.24 Does pica go away? Why do I crave tissue? "Desidero" can also be indicative of a reduction in iron, which relates to iron deficiency. For this, we propose the term "desideromastica" derived from the Latin words "desiderare" for desire and "mastica" for chew. Our patient experience provides suggestive evidence that oral tactile craving symptoms, distinct from ice pica, exists in a subset of patients suffering from IDA. The lone patient with persistent symptoms had a baseline ferritin of 10 µg/L, improved to 398 µg/L after replacement, and settled back at 42 µg/L three months later. Overall, 88.9% (8/9) reported resolution of chew cravings after iron repletion. Oral (ferrous glyconate or ferrous fumarate) and intravenous (ferric carboxymaltose, iron sucrose, or low molecular weight iron dextran) iron replacement were used in 33.3% (3/9) and 66.7% (6/9) patients, respectively. In total, 9 patients proceeded with observed treatment of their IDA with clinical follow-up and laboratory confirmation of iron repletion. Only 16.7% (2/12) reported concurrent ice pica. Many patients reported the frequency and satisfaction of these cravings resulted in jaw pain as well as the persistence of cravings despite this discomfort. Tactile cravings included chewing gum (3), mastic gum (2), ginseng (1), dry oats (1), crackers (1), pickles (1), chips (1), sawdust (1), and knitting rope (1). All patients were female and the median age was 41.5 years (33-59). We observed 12 patients with IDA who self-reported chew cravings during initial evaluation. Information including sociodemographics, substance craved, values of hemoglobin (Hgb), mean corpuscular volume (MCV), and ferritin before and after iron replacement therapy, and symptom resolution after treatment were recorded. This study included patients from the Mayo Clinic (Rochester, MN) and Ankara Training and Research Hospital (Ankara, Turkey) Hematology practices who self-reported tactile mastication cravings during initial evaluation for IDA between 1/1/18 and 6/30/19. In our practice we observed a subset of patients with IDA who report specific tactile cravings associated with mastication. Olfactory cravings associated with IDA are a recently described phenomenon known as desiderosmia. The compulsive craving and consumption of non-food substances, known as pica, is a well-documented symptom associated with iron deficiency anemia (IDA).
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