Xylophagia is a form of pica where patients have the unusual craving for ingestion of paper. You can usually correct iron deficiency anemia with iron. As a result, iron deficiency anemia may leave you tired and short of breath. Without enough iron, your body cant produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). Upon follow‐up of 8 weeks after iron replacement therapy, her cravings had completely resolved and she was no longer eating toilet paper. As the name implies, iron deficiency anemia is due to insufficient iron. She received three doses of intravenous iron replacement therapy with normalization of her ferritin (89.3 ng/mL ). Upon further questioning, patient reported pica and craving for toilet paper and endorsed eating up to two rolls of toilet paper daily. No active source of bleeding was identified. Patient was given additional polyethylene glycol 3350 and electrolytes followed by repeat colonoscopy with assistance from large volume of water evacuation, which showed small fragments of toilet paper from the sigmoid colon (Figure 1A arrow) up to the terminal ileum better visualized after removal from the colon (Figure 1B arrow). Colonoscopy revealed extensive foreign body, throughout the colon making it difficult to advance the colonoscope beyond the sigmoid colon. While on anticoagulation for her PE and SVC thrombosis, she developed hematochezia and workup revealed iron deficiency anemia (ferritin 8.1 ng/mL, hemoglobin 7.0 gm/dL, MCV 77.4 fl ). She was enrolled in a monthly exchange transfusion program and was on folic acid supplementation. The incidence of anemia is as much as 53.2 per cent among women and 21.7 per cent among men, says Dr Sanyal, adding that one can treat iron deficiency anemia with supplements. Other complications of Hgb SS disease included two CVAs and several admissions for pain crises. Indeed, by determining maternal and chord blood lead levels in pregnant women in Congo, Gundacker et al. A 32‐year‐old woman with a history of homozygous sickle cell anemia (Hgb SS disease) was started on anticoagulation with apixaban 5 mg BID for superior vena cava thrombosis and pulmonary embolism. Besides anemia, kaolin absorption may expose consumers to a much neglected aspect of pica: the risk of overexposure to metals contained in soils.
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