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Haemoglobin is usually slightly low due to the anaemia of chronic disease. This is a secondary sideroblastic anaemia that results from impaired transfer of iron to red blood cells in states of illness. Anaemia in anorexia nervosa can also be due to deficiencies of iron, vitamin B12, folic acid and, rarely, copper. Anaemia can be caused by self-phlebotomy. Self-phlebotomy should be suspected if haemoglobin level drops quickly, if haemoglobin level has dropped more than 30%, if there is an associated iron deficiency, if there is no nutrient deficiency or if there are unexplained needle marks. Almost all cases of self-phlebotomy occur in health care workers. Rarely, marrow failure will result from drug toxicity or just from malnutrition itself. This can be life-threatening. |
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