Surviving Critical Low Hemoglobin Levels and Pica.

Iron deficiency is the most common nutritional deficiency. Pica is commonly associated with iron deficiency anemia (IDA). A case of a 40-year-old female who presented with a critical record of low hemoglobin (Hgb) (1.6 g/dL) with severe iron deficiency and pica with no lasting deficits despite such low hemoglobin is discussed in this article. The patient presented to the emergency room with complaints of weight loss, weakness, palpitation, fatigue, dysphagia, and on-and-off vomiting for about a year and severe menorrhagia for about one and a half years. She also has had pica for the past several years where she eats and chews toilet paper. Several of her female family members also have pica. She was found to have critically low hemoglobin of 1.6 g/dL and serum iron of 8 ug/dL and ferritin of less than 1 ng/mL. The patient was treated with six units of packed red blood cells and IV and oral iron supplementation. She was discharged with a hemoglobin of 7.3 g/dL. She was later found to have a 9.6 cm uterine mass that is consistent with leiomyoma (fibroid) in transvaginal ultrasound and is following up with a gynecologist for the definitive management. She did not have lasting deficits from the critically low hemoglobin and has stopped engaging in pica behavior.