Hematological complications in anorexia nervosa

Abstract

Background/objectives:Anemia, leukopenia and, although less frequently, thrombocytopenia are possible hematological complications of anorexia nervosa considered strictly secondary to chronic malnutrition. This is a retrospective study on the prevalence of these disorders in a large cohort of 318 female patients with AN (20.4±5.6 years, body mass index (BMI) 15.9±1.6 kg/m2), recruited in the Outpatient Unit for Malnutrition secondary to Eating Disorders at the Department of Clinical Medicine and Surgery, Federico II University Hospital, since February 1991 to December 2012.Subjects/methods:Patients were studied on an outpatient basis after obtaining medical history, clinical examination, routine hematobiochemical and endocrine tests, electrocardiography, psychiatric interview and bioelectrical impedance analysis and, in particular, phase angle determination. All patients with other comorbidities, in particular with mean corpuscular volume <80 fl, were excluded for suspected genetic alteration in the synthesis of hemoglobin.Results:Hematologic data showed that 16.7% of patients had anemia, 7.9% neutropenia and 8.9% thrombocytopenia. These abnormalities were strictly related to the duration of illness (P=0.028), and to protein energy malnutrition, in particular, BMI and phase angle (P<0.001).Conclusions:Our study offers description of the incidence of hematologic defects in a selected and large sample of AN female patients, suggesting that its incidence is related to the degree and duration of protein energy malnutrition.

Management of Refeeding Syndrome in Medical Inpatients

“…Severely malnourished patients may suffer from hematological disorders and moderate to high increase of liver enzymes. The first pathophysiological changes are associated with bone marrow hypoplasia and with gelatinous marrow transformation [83,84]; the second seems to be multicausal and related to an ischemic hepatitis secondary to liver hypoperfusion, to oxidant stress from low glutathione levels, and to starvation-induced autophagy [83,85]. Both pathologies show a marked decrease after a few days during the replenishment phase (hydration and nutritional therapy) and possibly will normalize after the refeeding period [86].…”

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

“…Malnutrition mainly leads to endocrinological and cardiological disorders, as well as to multiple abnormalities within the digestive, skeletal, and reproductive system. Changes mentioned above are accompanied by hematological and biochemical changes, among others [ 7 , 9 , 10 ]. In recent years a few new molecules and parameters have been described that could play a significant role in regulation of energy homeostasis.…”

Increased naive CD4+ and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients

“…In AN, immune disturbances are most likely the result of nutritional deprivation, and in this sense, normalization with re-feeding and clinical recovery has been reported [9,13]. The extent of the immune and metabolic changes depends on the duration and severity of the reduced food intake and the amount of weight lost [11,12,17]. As a result, different white blood cell types might be differentially affected by the degree of malnutrition.…”