Abstract
Little is known about the prevalence of hematologic abnormalities in adults with severe anorexia nervosa. We report the first major analysis of hematologic dysfunction in such patients. We retrospectively analyzed the charts of 53 men and women with severe anorexia nervosa, admitted between October 2008 and December 2010 for medical stabilization to our center, which has a national referral base. Patients were predominantly female (89 %), with a median age of 28 years (range 17–65), and were hospitalized for a median duration of 15 days (I.Q.R. 9–29). Nadir body mass index during hospitalization was markedly low at 12.4 kg/m2 (range 8.4–15.7), and the mean discharge BMI was 13.8 kg/m2 (range 10.2–16.8). 83 % of patients were anemic (hematocrit <37 %), with only 3 (6 %) having iron deficiency. 79 % were leukopenic (WBC < 4.5 k/μL), 29 % were neutropenic (ANC < 1.0 k/μL), 25 % were thrombocytopenic (platelets < 150 k/μL), and 17 % of patients developed thrombocytosis (platelets > 400 k/μL) during their hospitalization. Eighty-nine percent of patients had resolved their neutropenia by discharge. Marked hematologic deficiencies are often present in patients with severe anorexia nervosa, generally attributed to starvation-mediated gelatinous marrow transformation which resolves with proper nutritional rehabilitation. Improved provider awareness of this association may reduce unnecessary testing and costly treatment interventions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF (2008) Variations in admissions practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health 43:425–431
American Psychiatric Association (2006) Treatment of patients with eating disorders, 3rd 3d. Am J Psychiatry 163(Suppl 7):4–54
American Dietetic Association (2006) Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders. J Am Diet Assoc 106:2073–2082
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition): DSM-IV. American Psychiatric Association, Washington, DC
Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284
Rosling AM, Sparén P, Norring C, von Knorring AL (2011) Mortality of eating disorders: a follow-up study of treatment in a specialist unit 1974–2000. Int J Eat Disord 44:304–310
Making Sense of ED Mortality Statistics. National Association of Anorexia Nervosa and Associated Disorders. http://www.anad.org/get-information/about-eating-disorders/making-sense-of-ed-mortality-statistics/. Accessed on April 17, 2012.
Eating Disorders: Core Interventions in the Treatment of and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Institute for Clinical Excellence, Clinical Guideline 9. http://guidance.nice.org.uk. Accessed on December 22, 2010.
Cleary BS, Gaudiani JL, Mehler PS (2010) Interpreting the complete blood count in anorexia nervosa. Eat Disord 18:132–139
Hutter G, Ganepola S, Hofmann WK (2009) The hematology of anorexia nervosa. Int J Eat Disord 42:293–300
Miller KK, Grinspoon SK, Ciampa J et al (2005) Medical findings in outpatients with anorexia nervosa. Arch Int Med 165:561–566
Misra M, Aggarwal A, Miller KK et al (2004) Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 114:1574–1583
Charania RS, Kern WF, Charkrabarty S, Holter J (2011) Successful management of gelatinous transformation of the bone marrow in anorexia nervosa with hematopoietic growth factors. Int J Eat Disord 44:469–472
Saito S, Kita K, Morioka CY, Watanabe A (1999) Rapid recovery from anorexia nervosa after a life-threatening episode with severe thrombocytopenia: report of three cases. Int J Eat Disord 25:113–118
Vignaud M, Constantin JM, Ruivard M et al (2010) Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study. Crit Care 14:R172
Mehler PS, Howe SE (1995) Serous fat atrophy with leukopenia in severe anorexia nervosa. Am J Hematol 49:171–172
Abella E, Feliu E, Granada I et al (2002) Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings. Am J Clin Path 118:582–588
Misra M, Tsai P, Anderson EJ et al (2006) Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. Am J Clin Nutr 84:698–706
Bohm J (2000) Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Path 24:56–65
Orlandi E, Boselli P, Covezzi R et al (2000) Reversal of bone marrow hypoplasia in anorexia nervosa: case report. Int J Eat Disord 27:480–482
Chu ES, Gaudiani JL, Mascolo M et al (2012) ACUTE center for eating disorders. J Hosp Med 7:340–344
Bowers TK, Eckert E (1978) Leukopenia in anorexia nervosa. Lack of increased risk of infection. Arch Intern Med 138:1520–1523
Acknowledgments
The authors acknowledge the administrative efforts of Adriana Padgett and the clinical staff of the ACUTE Center for Eating Disorders at Denver Health Medical Center.
Conflict of interest
The authors declare they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sabel, A.L., Gaudiani, J.L., Statland, B. et al. Hematological abnormalities in severe anorexia nervosa. Ann Hematol 92, 605–613 (2013). https://doi.org/10.1007/s00277-013-1672-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-013-1672-x