Severe neutropenia in an anorexic adolescent girl: a stigma of underfeeding syndrome?
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CASE REPORT
Severe neutropenia in an anorexic adolescent girl: a stigma of underfeeding syndrome? N. Ibrahim1 · A. Barruchet1 · M. R. Moro1,2,3 · C. Blanchet1,2,3 Received: 29 May 2020 / Accepted: 8 September 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose We describe a case of severe, prolonged neutropenia in an adolescent girl hospitalized for anorexia nervosa (AN) which occurred during a refeeding procedure in the absence of refeeding syndrome. Methods This case report includes retrospective anamnestic, clinical and biological data from the patient’s medical record. A literature review was conducted on the haematological changes described in the undernutrition and refeeding periods, and also on recent data for underfeeding syndrome in patients with anorexia nervosa. Conclusion Leuconeutropenia is an adaptive condition observed in undernutrition in AN, usually rapidly and completely reversible in the course of refeeding and weight gain. We describe a rare case of severe, prolonged neutropenia despite appropriate care in the absence of refeeding syndrome and without gelatinous bone marrow transformation. We suggest that neutropenia in adolescent anorexia nervosa could be a stigma of underfeeding syndrome resulting from an overly cautious refeeding strategy. Level of Evidence Level V, descriptive study. Keywords Anorexia nervosa · Adolescent · Neutropenia · Refeeding · Underfeeding syndrome
Introduction Haematological complications in anorexia nervosa (AN) are common and most often result from bone marrow hypometabolism secondary to undernutrition. Anaemia is found in 16.7–39% of cases, leucopenia in 7.9–36% of cases, and thrombocytopenia in 8.9–11.3% of cases [1, 2]. The severity of these conditions is correlated with the intensity and duration of undernutrition, and they are usually reversible with appropriate renutrition. Nevertheless, recommendations for caloric needs and refeeding strategies for AN patients are highly variable in the literature [3, 4]. We report here the case of a 16-year-old anorexic girl, hospitalized for severe
* C. Blanchet [email protected] 1
APHP, Cochin Hospital, Maison de Solenn, 75014 Paris, France
2
University of Paris, PCPP, 92100 Boulogne‑Billancourt, France
3
University of Paris-Saclay-UVSQ, INSERM, CESP, Team DevPsy, 94805 Villejuif, France
undernutrition, who presented severe, prolonged neutropenia in the course of refeeding in a specialized care unit.
Case presentation A 16-year-old adolescent girl of Franco-Japanese origin suffering from AN was hospitalized for a situation of terminal cachexia in a multidisciplinary specialized medical unit for eating disorders (EDs). On admission, BMI was 11.96 kg/m2 (29.5 kg/1.57 m) with various signs of adaptation to undernutrition such as bradycardia (40/min), hypotension (80/40 mmHg) and hypothermia (36 °C) but without any signs of multi-organ decompensation. There were no signs of confusion, but there were anorexic cognitions such as denial of weight loss and dysmorphophobia. No purgative beha
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