ORIGINAL ARTICLE Increased incidence of iron deficiency anemia secondary to inadequate iron intake in institutionalized, young patients with cerebral palsy Athanasios Papadopoulos Æ George Ntaios Æ Georgia Kaiafa Æ Fotios Girtovitis Æ Zoi Saouli Æ Zisis Kontoninas Æ Michael D. Diamantidis Æ Christos Savopoulos Æ Apostolos Hatzitolios Received: 11 September 2008 / Revised: 25 September 2008 / Accepted: 6 October 2008 / Published online: 11 November 2008 Ó The Japanese Society of Hematology 2008 Abstract We observed high incidence of anemia in patients with cerebral palsy sheltered in a specialized institution in Thessaloniki, Greece. Therefore, we decided to investigate its cause. We studied 108 patients, and assessed complete blood cell count, peripheral blood smear, serum iron, ferritin, folate, B12 and the presence of hemoglobin or parasites in the stools. In all cases, anemia was hypochromic and microcytic. Approximately 33% of patients suffered from hypochromic anemia, whereas 38% were iron deficient. There was no statistical difference in the incidence of iron deficiency between different age groups. All tests for fecal occult blood or intestinal para- sites were negative. Folic acid and B12 levels were within normal range in all cases. We also found that 87 and 95.6% of patients on liquid diet were anemic and iron deficient, respectively, compared to only 18.8 and 22.3% of patients on normal diet. The high incidence of anemia was attrib- uted to iron deficiency which was secondary to inadequate iron intake and decreased iron absorption. Thus, it would not be irrational to consider iron supplementation as the first measure in such patients and postpone endoscopic procedures for a later stage, unless there are clinical or laboratory findings (such as fecal occult blood) suggestive of gastrointestinal blood loss. Keywords Iron deficiency Á Hypochromic microcytic anemia Á Cerebral palsy Á Institutionalized patients Á Iron supplementation 1 Introduction Iron deficiency constitutes one of the most frequent causes of anemia [1]. Most usually, iron deficiency is attributed to chronic blood loss from genito-urinary or gastrointestinal tract [1]. On the contrary, iron deficiency anemia secondary to inadequate iron intake is extremely rare [2]. There are some reports of epidemics of iron deficiency due to low intake in certain vegan populations [3], in populations with high incidence of hookworm infection [4], as well as in severely disabled hospitalized patients [5, 6]. Thus, we thought it would be interesting to investigate our obser- vation of high incidence of iron deficiency anemia among patients with cerebral palsy sheltered in a specialized institute of our city. 2 Patients and methods We studied 108 patients (55 males, 53 females) ranging between 8 and 29 years that were hosted in a specialized institute in Thessaloniki, Greece, due to cerebral palsy. In most cases, cerebral palsy resulted from perinatal hypoxemia; other causes included craniocerebral traumas, infections of the central nervous system and hereditary disorders. We assessed complete blood cell count, peripheral blood smear and anemia-related biochemical parameters, such as serum iron, ferritin, folate, B12. Moreover, all patients A. Papadopoulos Á G. Ntaios (&) Á G. Kaiafa Á F. Girtovitis Á Z. Saouli Á Z. Kontoninas Á M. D. Diamantidis Á C. Savopoulos Á A. Hatzitolios First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University, 54636 Thessalonı ´ki, Greece e-mail: ntaiosgeorge@yahoo.gr 123 Int J Hematol (2008) 88:495–497 DOI 10.1007/s12185-008-0191-3