The Restrictive Type, Infectious Complications, a Long Duration of Illness Might Predict Nadir Hematological Values Among Individuals With Anorexia Nervosa During the Refeeding Period: A Retrospective Study

Abstract

BackgroundAlthough hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period, when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of anorexic inpatients during the refeeding period.MethodsWe recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures (hemoglobin, white blood cells, platelets) to determine their levels at admission and their lowest levels during the refeeding period and calculated the rate of decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator. ResultsThe initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 22.6 ± 10.1 ×104/μl decreased by 24.3% to 17.1 ± 8.0 ×104/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. The anorexia nervosa restrictive type was associated with a lower nadir level of hemoglobin and white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and platelet count. A longer duration of illness was associated with a lower nadir white blood cell count. ConclusionsNadir hematological cell measures of inpatients with anorexia nervosa during the refeeding period might be predicted by the restrictive type, infectious complications, and a long duration of illness. These factors might be used as indicators to guide clinical approaches for controlling hematological deficiencies during the refeeding period.