pica and Anemia

Although pica has long been associated with pregnancy, the exact prevalence in this population remains unknown.. To estimate the prevalence of pica during pregnancy and the postpartum period, and to explain variations in prevalence estimates by examining potential moderating variables.. PsycARTICLES, PsycINFO, PubMed, and Google Scholar were searched from inception to February 2014 using the keywords pica, prevalence, and epidemiology.. Articles estimating pica prevalence during pregnancy and/or the postpartum period using a self-report questionnaire or interview were included.. Study characteristics, pica prevalence, and eight potential moderating variables were recorded (parity, anemia, duration of pregnancy, mean maternal age, education, sampling method employed, region, and publication date). Random-effects models were employed.. In total, 70 studies were included, producing an aggregate prevalence estimate of 27.8% (95% confidence interval 22.8-33.3). In light of substantial heterogeneity within the study model, the primary focus was identifying moderator variables. Pica prevalence was higher in Africa compared with elsewhere in the world, increased as the prevalence of anemia increased, and decreased as educational attainment increased.. Geographical region, anemia, and education were found to moderate pica prevalence, partially explaining the heterogeneity in prevalence estimates across the literature.

Topics: Anemia; Female; Global Health; Humans; Maternal Age; Parity; Pica; Postpartum Period; Pregnancy; Pregnancy Complications; Risk Factors

Geophagia, the eating of dirt, usually clay, has been recorded in every region of the world both as idiosyncratic behavior of isolated individuals and as culturally prescribed behavior of particular societies. The behavior has long been viewed as pathological by the medical profession, and it has been claimed to be both a cause and a consequence of anemia. While there is now reason to believe that the consumption of some clays may interfere with the absorption of elemental iron, zinc, and potassium, there is little evidence for the position that geophagia, especially its culturally prescribed form, is caused by anemia. These and other maladaptive consequences of clay consumption may be offset by the adaptive value of its antidiarrheal, detoxification, and mineral supplementation potentials.

Topics: Adaptation, Biological; Anemia; Female; Humans; Pica; Poisoning; Pregnancy; Pregnancy Complications; Soil

Topics: Adult; Anemia; Blood Chemical Analysis; Brain Diseases; Child, Preschool; Edetic Acid; Environmental Exposure; Gout; Humans; Infant; Lead; Lead Poisoning; Nephritis; Neuromuscular Diseases; Pica; Skin Absorption

Topics: Anemia; Child, Preschool; Female; Humans; Mother-Child Relations; Object Attachment; Pica; Psychotherapy; Soaps

This study was conducted to determine the relationship between pica and anemia, gastrointestinal disorders, as well as pregnancy outcomes in pregnant women.. This study was a prospective study carried out between January 2016 and June 2017 and was performed on 226 pregnant women who attended four different health care centers to receive routine prenatal care. Sampling was done considering the inclusion criteria, in two steps: cluster sampling and random sampling. Data collection was done using a researcher-made checklist. The significance level was set at p = 0.05.. The average age of the participants was 26.10±6.27. The prevalence of pica in pregnant women in the first, second, and third trimesters was 9.3, 8, and 2.1%, respectively. The most common pica craving among pregnant women was for ice and frozen materials (68.2%). There was a statistically significant relationship between gastrointestinal disorders and anemia with pica (p < 0.001). There was also a significant relationship between birth weights of babies born to mothers with pica and those without pica (p = 0.005).. Pica in pregnant women had a significant relationship with gastrointestinal disorders and anemia during pregnancy and pregnancy outcomes. Thus, in addition to providing healthcare services, health care professionals should consider patients' pica practices and make the necessary interventions.

Topics: Adult; Anemia; Birth Weight; Checklist; Comorbidity; Correlation of Data; Female; Gastrointestinal Diseases; Humans; Infant, Newborn; Pica; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimesters; Prenatal Care; Prevalence; Prospective Studies

Topics: Anemia; Blood Transfusion; Edema; Ferric Compounds; Ferric Oxide, Saccharated; Ferrous Compounds; Foot; Glucaric Acid; Hematinics; Humans; Infant; Male; Oxygen Inhalation Therapy; Pica

Geophagy or soil eating is mostly described in pregnant women from Sub-Saharan Africa, South America. Here, we report 12 cases of geophagy associated with severe anemia in non-pregnant Nigerian women.. The median age at diagnosis was 34.5 years. The socioeconomic level was average for all patients. The median hemoglobin level at admission was 6.9g/dL (3.3-8.6), median corpuscular volume was 78.3fL (63-106) and median serum ferritin was 9.2ng/mL (3.6-11.2). The reasons of this practice were "desire" (5/12) and tradition (4/12). All patients received psychotherapy and supplementation with intravenous iron.. Geophagy is an underestimated practice in developed countries and in non-pregnant women. It can be the cause of severe iron deficiency and must be discussed in patients with anemia, including non-pregnant patients, and in Africa as well as in migration areas, where the practice can be exported.

Topics: Adolescent; Adult; Anemia; Cohort Studies; Female; Hospitalization; Humans; Pica; Severity of Illness Index; Young Adult

Pregnancy during the adolescent period is challenging mainly because of the nutritional demands of both the adolescent and pregnancy period. The risk for anaemia increases especially in developing countries such as Ghana where malaria is endemic and the practice of pica is common. In this study, we sought to determine the prevalence of anaemia, pica practice and malaria infection among pregnant adolescent girls and assess the extent to which these factors are associated.. Two hundred and sixty five (265) pregnant adolescent girls were recruited from three hospitals in Accra. Haemoglobin levels, malaria infection and the practice of pica were assessed. Pearson's Chi squared tests were used to determine associations and logistic regression analysis was used to determine the odds of being anaemic. Significance was set at p≤0.05.. Anaemia prevalence was 76% with severity ranging from mild (47.8%) to severe (0.8%). About 27.5% were moderately anaemic. Pica was practiced in only 9.1% of the girls. Malaria infection was prevalent in 17.7% of the girls. The logistic regression analysis indicated that pregnant girls with malaria infection were 3.56 times more likely to be anaemic when compared to those without malaria. Also, those who practiced pica were 1.23 times more likely to be anaemic when compared to those who did not practice pica.. Anaemia is very prevalent in pregnant adolescent girls and is a public health problem. Drastic measures should be taken to reduce the high prevalence.

Topics: Adolescent; Anemia; Cross-Sectional Studies; Female; Ghana; Humans; Logistic Models; Malaria; Pica; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Pregnancy Complications, Parasitic; Pregnancy in Adolescence; Prevalence; Severity of Illness Index; Young Adult

Anemia during pregnancy is a common problem in developing countries and affects both the mother's and her child's health. The main objective of this study was to determine the prevalence of and the factors associated with anemia among pregnant women.. Facility based cross-sectional study design was conducted from June to August, 2011 on 374 pregnant women. Mothers who came for ANC during the study period and who met the inclusion criteria were interviewed and a capillary blood sample was taken. Hemoglobin level was determined by using HemoCue photometer, and interviewer administered questionnaire was used to collect data. Data were cleaned, coded and fed into SPSS version 16.0 for analysis.. The mean hemoglobin concentration was 12.05±1.5 g/dl and prevalence of anemia was 36.6%. Family sizes (COR=2.67, CI (1.65, 4.32), third trimester (COR=1.45, CI (1.11, 2.23), meat consumption <1x/wk (COR=3.47, CI (1.58, 7.64) and pica (COR=2.33, CI (1.52, 3.58) were significantly associated with anemia. Having five or more children (AOR=5.2, CI [1.29, 21.09]), intake of vegetables and fruits less than once per day (AOR= 6.7, CI [2.49, 17.89]), intake of tea always after meal (AOR = 12.83.CI [45-28.9]), and recurrence of illness during pregnancy (AOR=7.3, CI [2.12-25.39]) were factors associated with anemia.. This study showed that anemia is a moderate public health problem. Less frequent meat and vegetable consumption, parity ≥5 are risk factors for anemia. Therefore, reducing parity, taking balanced diet and use of mosquito nets during pregnancy are recommended.

Topics: Adult; Anemia; Cross-Sectional Studies; Diet; Ethiopia; Feeding Behavior; Female; Hemoglobins; Humans; Interviews as Topic; Maternal Health Services; Odds Ratio; Parity; Pica; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Prenatal Care; Prevalence; Recurrence; Risk Factors; Surveys and Questionnaires; Tea; Young Adult

Pica is the compulsive consumption of non-nutritive substances, and this disorder may occur more frequently in dialysis patients. The purpose of our study was to determine the prevalence of pica and the associated demographic and metabolic characteristics.. Retrospective, cross-sectional analysis.. Hospital-based, outpatient, pediatric hemodialysis unit.. Eighty-seven pediatric patients on chronic dialysis therapy were interviewed. Sixty-seven patients were receiving hemodialysis, whereas the remaining 20 were maintained on peritoneal dialysis. The predominantly nonwhite (93%) patient population had a mean age of 17.2 ± 7.2 years. Dialysis efficiency, estimated by urea clearance per patient volume (Kt/V), averaged 1.5 ± 0.5.. Standard patient interview and documentation of laboratory and dialytic parameters.. Prevalence of pica and associated comorbid conditions.. The survey indicated that 46% of patients experienced pica, further divided into simple "ice" pica (34.5%) versus "hard" pica (12.6%). Hard pica included the consumption of chalk, starch, sugar, soap, sand, clay, Ajax cleanser, sponge, wood, and potting soil. Patients on hemodialysis were 8.3 times more likely to have hard pica compared with those on peritoneal dialysis. Greater than 5 years on dialysis was associated with a 3.2 odds ratio of having pica (P = .02). Anemia was the most significant morbid association, occurring at an odds ratio of 4.4 (P = .001) for all pica and 10.6 (P = .004) for hard pica.. Pica, therefore, is prevalent and potentially harmful, requiring further attention in the nutritional management of pediatric dialysis patients.

Topics: Adolescent; Anemia; Child; Chronic Disease; Cross-Sectional Studies; Female; Humans; Male; Nutrition Assessment; Odds Ratio; Peritoneal Dialysis; Pica; Prevalence; Renal Dialysis; Retrospective Studies; Urea; Young Adult

Topics: Adaptation, Physiological; Anemia; Animals; Diet; Gastrointestinal Diseases; Humans; Hunger; Minerals; Pica; Sorption Detoxification

Topics: Adolescent; Adult; Anemia; Animals; Female; Humans; Middle Aged; Parasites; Parasitic Diseases; Pica; Prevalence; Tunisia; Young Adult

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Animals; Female; Humans; Pica; Porifera; Young Adult

The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.

Topics: Anemia; Anemia, Iron-Deficiency; Female; Hemoglobins; Humans; Iron, Dietary; Pica; Pregnancy; Pregnancy Complications, Hematologic; Tanzania

The clays consumed by geophagous individuals contain large quantities of aluminum, a known neurological and hematological toxin. This is the first study to evaluate the risk of aluminum poisoning in geophagous individuals. Blind determinations of plasma and urinary aluminum concentrations were carried out in 98 anemic geophagous pregnant women and 85 non-anemic non-geophagous pregnant women. Aluminum concentrations were significantly higher (P < 0.0001) in the geophagous anemic women than in the controls, with odds ratios of 6.83 (95% confidence interval [CI] = 2.72-19.31) for plasma concentrations (13.92 ± 14.09 μg/L versus 4.95 ± 7.11 μg/L) and 5.44 (95% CI = 2.17-14.8) for urinary concentrations (92.83 ± 251.21 μg/L versus 12.11 ± 23 μg/L). The ingested clay is the most likely source of this overexposure to aluminum. If confirmed, the clinical consequences of this absorption for pregnant women and their offspring should be explored.

Topics: Adult; Aluminum; Aluminum Silicates; Anemia; Case-Control Studies; Clay; Female; French Guiana; Humans; Pica; Pregnancy; Pregnancy Complications; Young Adult

Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37-2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98-1.36) and a lower hemoglobin concentration (adjusted-mean difference -3.8 g/L; 95% CI [-7.3, -0.4]). Pregnant women should be informed about the potential risks associated with soil consumption.

Topics: Adult; Anemia; Animals; Ascariasis; Ascaris lumbricoides; Female; Helminthiasis; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Longitudinal Studies; Pica; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors; Socioeconomic Factors; Soil; Tanzania; Vitamin A

Pica, the craving and subsequent consumption of non-food substances such as earth, charcoal, and raw starch, has been an enigma for more than 2000 years. Currently, there are little available data for testing major hypotheses about pica because of methodological limitations and lack of attention to the problem.. In this paper we critically review procedures and guidelines for interviews and sample collection that are appropriate for a wide variety of pica substances. In addition, we outline methodologies for the physical, mineralogical, and chemical characterization of these substances, with particular focus on geophagic soils and clays. Many of these methods are standard procedures in anthropological, soil, or nutritional sciences, but have rarely or never been applied to the study of pica.. Physical properties of geophagic materials including color, particle size distribution, consistency and dispersion/flocculation (coagulation) should be assessed by appropriate methods. Quantitative mineralogical analyses by X-ray diffraction should be made on bulk material as well as on separated clay fractions, and the various clay minerals should be characterized by a variety of supplementary tests. Concentrations of minerals should be determined using X-ray fluorescence for non-food substances and inductively coupled plasma-atomic emission spectroscopy for food-like substances. pH, salt content, cation exchange capacity, organic carbon content and labile forms of iron oxide should also be determined. Finally, analyses relating to biological interactions are recommended, including determination of the bioavailability of nutrients and other bioactive components from pica substances, as well as their detoxification capacities and parasitological profiles.. This is the first review of appropriate methodologies for the study of human pica. The comprehensive and multi-disciplinary approach to the collection and analysis of pica substances detailed here is a necessary preliminary step to understanding the nutritional enigma of non-food consumption.

Topics: Aluminum Silicates; Anemia; Chemistry Techniques, Analytical; Clay; Feeding Behavior; Health Behavior; Humans; Pica; Research Design; Soil; Specimen Handling

Acquired copper deficiency anemia is rare in humans. This report describes a 38-year-old schizophrenic man with metal pica, especially coins, who presented with symptomatic anemia. Two hundred seventy-five coins were surgically removed from the gastrointestinal tract of this patient during the course of his hospitalization. Some of the post-1981 pennies, which consist primarily of zinc, showed severe corrosion because of their prolonged contact with acidic gastric juice. The patient presented with clinical manifestations consistent with the local corrosive as well as the systemic effects of zinc intoxication. His treatment and outcome are presented. The effects of zinc intoxication on hematologic and other organ systems and on copper absorption are discussed.

Topics: Anemia; Copper; Foreign Bodies; Gastrointestinal Tract; Humans; Male; Middle Aged; Numismatics; Pica; Schizophrenia; Zinc

Topics: Adult; Anemia; Female; Humans; Pica; Wood

Topics: Adult; Aluminum Silicates; Anemia; Child; Clay; Diet; Female; Humans; Male; Nutritive Value; Pica; Pregnancy; Soil

To determine the prevalence of pica during pregnancy, maternal hemoglobin levels at delivery, and the association of pica with 2 adverse pregnancy outcomes: low birth weight and preterm birth.. A retrospective cohort study was conducted using eligible subjects (n=281) from a cross-sectional survey (n=366).. Mothers aged 16 to 30 years with infants younger than 1 year of age who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interviewed at 4 WIC clinics in Houston and Prairie View, Tex. Medical records from 31 hospitals were abstracted.. Maternal hemoglobin levels at delivery, mean birth weight, and mean gestational age were compared for women who reported pica and women who did not.. Chi(2) tests, orthogonal t tests, analysis of variance, and regression analysis were used to test the relationships among study variables.. Pica prevalence categorized by substance was as follows: ice, 53.7%; ice and freezer frost, 14.6%; other substances such as baking soda, baking powder, cornstarch, laundry starch, baby powder, clay, or dirt, 8.2%; and no pica, 23.5%. Women in all 3 pica groups had lower hemoglobin levels (mean+/-standard deviation, 114+/-12 g/L, 110+/-13 g/L, and 113+/-12 g/L, respectively) at delivery than women who did not report pica (118+/-11 g/L) (P<.01 for all pica groups vs no pica). There were no differences in mean birth weight or mean gestational age of infants born to women from the 3 pica groups and the No Pica group.. The findings suggest that pica practices are associated with significantly lower maternal hemoglobin levels at delivery but are not associated with pregnancy outcomes. Dietitians should ask pregnant women with anemia about pica and should counsel women who report pica regarding the health risks associated with it.

Topics: Adolescent; Adult; Anemia; Chi-Square Distribution; Cohort Studies; Cross-Sectional Studies; Female; Hematocrit; Hemoglobins; Humans; Pica; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Pregnancy Outcome; Prevalence; Retrospective Studies; Smoking

This study examined prevalence and correlates of anemia in the Muynak District of Uzbekistan, an area of rapidly changing social and economic conditions following the collapse of the Soviet Union.. Questionnaire data and blood samples were collected on a random sample of 433 children aged 1 through 4 years.. The prevalence of anemia ranged from 89% in 1-year-olds to 48% in 4-year-olds. Correlates for anemia included younger age, a communal water source, and a history of pica.. Anemia is a widespread problem in young children in this district. An aggressive attempt to reverse this problem is needed.

Topics: Anemia; Anemia, Iron-Deficiency; Child, Preschool; Female; Humans; Infant; Logistic Models; Male; Pica; Prevalence; Surveys and Questionnaires; Uzbekistan; Water Supply

As part of a cross-sectional study among 156 primary school children (median age 13 years, range 10-18) in Western Kenya, geophagy was assessed through interviews. 114 (73.1%) of these children reported eating soil daily. Haemoglobin levels were determined in all 156 children and serum ferritin concentrations in 135. The mean haemoglobin (Hb) concentration was 12.7 g/dl, and median ferritin concentration 27.2 microg/l. Both the proportion of anaemic (Hb < 11.0 g/dl) and of iron-depleted (ferritin < 12 microg/l) children was significantly higher among the geophageous children than among the nongeophageous (9.6% vs. 0% anaemia; P = 0.037; 18.4% vs. 5.4% iron depletion; P = 0.046). Serum ferritin and haemoglobin concentrations were not correlated (r = 0. 13 5; P = 0. 100). Multiple regression analysis showed that geophagy, hookworm eggs per gram faeces and malaria parasite counts per microl blood were independent predictors of serum ferritin, when controlling for other helminth infections, age and sex, and socio-economic and educational background of the children's families and family size (y = 36.038-11.247(geophagy) -- 0.010(hookworm epg) + 0.001(malaria parasite counts); R2 = 0.17). Multiple regression analysis with haemoglobin as dependent variable and the same independent variables did not reveal any significant predictors. Analysis of the soil eaten by the children revealed a mean HCl-extractable iron content of 168.9 mg/kg (SD 44.9). Based on the data on the amounts eaten daily and this mean iron content, soil could provide on average 4.7 mg iron to a geophageous child (interquartile range 2.1-7.1 mg), which is equivalent to 32% of the Recommended Nutrient Intake (RNI) for girls (interquartile range 14-48%) or 42% of the RNI for boys (interquartile range 19-63%). Iron depletion and anaemia are associated with geophagy, but only serum ferritin concentrations were shown to be dependent upon geophagy in the regression model. From the cross-sectional data no inference about causality can be made. To clarify the possible causal relationships involved, longitudinal studies and iron-supplementation intervention studies are needed.

Topics: Adolescent; Aluminum; Anemia; Child; Cross-Sectional Studies; Female; Ferritins; Hemoglobins; Humans; Iron; Kenya; Male; Pica; Prevalence; Regression Analysis; Soil; Zinc

Topics: Adult; Africa; Anemia; Female; Humans; Pica

Topics: Anemia; Appetite; Child; Feeding and Eating Disorders; Female; Humans; Iron Deficiencies; Kidney Failure, Chronic; Male; Nutritional Physiological Phenomena; Pica; Renal Dialysis; Zinc

Topics: Anemia; Child; Child, Preschool; Hepatomegaly; Humans; Pica; Senegal; Soil

Topics: Age Factors; Anemia; Child, Preschool; Cobalt Isotopes; Female; Fluorescence; Housing; Humans; Infant; Lead; Lead Poisoning; Male; Methods; Ohio; Paint; Pica; Radiography; Socioeconomic Factors; Spectrometry, Fluorescence; Spectrum Analysis

Topics: Anemia; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Iron; Pica; Pregnancy; Pregnancy Complications, Hematologic

Topics: Adult; Air; Anemia; Brain; Child; Child, Preschool; Environmental Health; Feces; Female; Food Analysis; Humans; Infant; Lead; Lead Poisoning; Male; Maximum Allowable Concentration; Pica; Time Factors; Water

Topics: Anemia; Black People; Feeding and Eating Disorders; Feeding Behavior; Humans; Infant; Male; Pica; Starch

Topics: Anemia; Anemia, Hypochromic; Child; Diagnosis; Feeding and Eating Disorders; Humans; Pica

Topics: Anemia; Anemia, Hypochromic; Black People; Feeding and Eating Disorders; Foreign Bodies; Gastrointestinal Tract; Humans; Pica; Radiography; United States

Topics: Adolescent; Anemia; Anemia, Hypochromic; Cachexia; Drug Therapy; Feeding and Eating Disorders; Humans; Hypokalemia; Iron; Iron-Dextran Complex; Pica; Potassium; Social Conditions

Topics: Adolescent; Anemia; Child; Deficiency Diseases; Dyspepsia; Feeding and Eating Disorders; Helminthiasis; Humans; Infant; Infant Nutrition Disorders; Pica

Topics: Anemia; Anemia, Hypochromic; Child; Feeding and Eating Disorders; Humans; Infant; Iron; Pica

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Feeding and Eating Disorders; Humans; Pica

Topics: Anemia; Anemia, Hypochromic; Child; Hematologic Diseases; Humans; Infant; Pica; Tracheophyta

Topics: Anemia; Anemia, Hypochromic; Appetite; Feeding and Eating Disorders; Humans; Iron; Iron Metabolism Disorders; Pica

Topics: Anemia; Anemia, Iron-Deficiency; Child; Cobalt; Humans; Infant; Infant, Newborn; Iron; Pica

Topics: Anemia; Child; Feeding and Eating Disorders; Humans; Hypersplenism; Hypertension, Portal; Idiopathic Noncirrhotic Portal Hypertension; Infant; Liver Cirrhosis; Pancytopenia; Pica; Splenomegaly

Topics: Achlorhydria; Anemia; Anemia, Hypochromic; Child; Humans; Infant; Lead Poisoning; Male; Pica; Urine