Characterization of pica prevalence among patients with sickle cell disease

Objective: To determine the prevalence of pica and its characteristics amon g 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 fr om March 1, 1998, to June 30, 1999, were reviewed. Patients were excluded f or 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 blo od 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 i ncluded paper, foam, and powders. There was a significantly higher prevalen ce of pica among patients homozygous for Hb S (Hb SS, sickle cell anemia) c ompared with the combined group of double heterozygous patients with Hb SC, Hb SD, and Hb S beta thallasemia (S beta (+) or S beta (0)) (35.6% vs 25.5 %, P=.03). Within genotype, mean Hb levels were significantly lower and ret iculocyte counts were significantly higher in the patients with pica. Overa ll, the mean age of patients with pica was significantly lower; however, th e prevalence was 233% (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 w ith 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 unc lear whether pica is a specific marker of disease severity, because our rev iew did not show a relationship to increased number and duration of hospita lizations. The association between pica and low body weight suggests a nutr itional effect on its prevalence.