汎血球減少症を呈したFactitious anemiaの1例

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A 34-year-old single female nurse was refered to our psychosomatic unit due to severe anemia and loss of consciousness. Her mother and younger sister were also nurses, but her father had died from malignant lymphoma 4 years before. Laboratory data revealed iron deficiency anemia. On admission, she had a mild fever and was vomiting. She was administered a blood transfusion because her hematologic data showed pancytopenia as Hgb. 3.3g/dl, W.B.C. 1700/, μl, Pit. 6.7×10^4/μl. We found she had syringes and needles and observed her self-induced bloodletting. Furthermore she had complicated alopecia areata and trichotillomania. Her anemia was gradually treated by intravenous ferrous injection and she was discharged from hospital. During outpatient treatment, the vomiting disappeared and binge eating appeared. Nevertheless, she was readmitted because of the progression of anemia and dehydration due to vomiting and wrist cutting. Her vomiting continued and she had pyrexia due to factitious behavior like self-induced leakage of instillation instead of self-induced bloodletting. We assessed that her life history of self-sacrifice was related to her masochistic pathology. For example, she injured herself through self-induced bloodletting and she overdrove herself in spite of having a severe anemia. We regarded this case's self-induced bloodletting not only as compulsive behavior but also as an equivalent to drug addiction. We reviewed 11 factitious anemia cases including this case in Japan. They were aged from 21 to 42 (average of 28.1±5.8) ; of the 9 females, 7 were in medical professions, especially nurses. Minimum data of Hgb., W.B.C. and Pit. are 1.3g/dl, 8001/μl, 6.7x10^4/μl (this case) respectively. 4 cases were accompanied with eating disorders. Patients diagnosed as having factitious disorders often give up treatment, so that their prognoses are pessimistic. So, after making an early definite diagnosis, we emphasize that the first step of the therapy should be to make a continuous therapeutic collaboration
日本心身医学会の論文
1995-04-01

汎血球減少症を呈したFactitious anemiaの1例

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