The Haematology of Anorexia Nervosa

S ummary . The haematological features of six patients with anorexia nervosa have been studied in a prospective fashion. Hypocellularity and the presence of large amounts of gelatinous acid mucopolysaccharide in the bone marrow has been confirmed and appears to be a common feature of this disorder. Rapid reversal occurred with clinical improvement in one patient. It is suggested that this represents a physiological response to starvation and evidence is presented that these changes are of minimal functional significance in most patients. Although mild subclinical deficiency of iron and folic acid, a slightly reduced red-cell lifespan and a relative increase in plasma volume may also occur, anaemia is not universal and is usually mild. Plasma volume changes are probably the major mechanism. Neutropenia was common and is probably due to redistribution of granulocytes within the various granulocyte compartments. Lymphopenia and thrombocytopenia were also found. Morphological abnormalities of the red cells were a frequent finding, particularly the presence of spur cells. These were not associated with abetalipoproteinaemia nor with biochemical evidence of liver disease and did not appear to be subject to significant haemolysis. These haematological changes are also reversible with improvement in nutritional status. Blue-green granules, probably representing ceroid, were observed in marrow histiocytes. The various abnormalities are discussed in relation to current concepts of the role of nutrition in haematopoiesis in man and haematopoietic roles for dietary factors other than protein are tentatively proposed.