Abstract
Background and aims: We aim to
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1. Present three cases where severe head lice infestation was associated with significant iron deficiency anaemia.
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2. Critically evaluate the available evidence to identify whether head lice infestation can cause anaemia by chronic blood loss.
Methods: Case series; literature review
Results: 3 patients were seen with head lice hyperinfestation and severe anaemia-
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1. A 3-year-old girl with poor hygiene and developmental delay
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2. The 5-year-old sibling of the above child
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3. A 15-year-old girl, under psychiatric follow up.
Extensive laboratory investigations and dietary evaluation failed to reveal a cause for anaemia. The anaemia and head lice infestation could well be coincidental findings.
Literature review identified studies in cattle which showed strong association of louse infestation and anaemia. No similar studies were identified in humans. Head lice can cause anaemia in humans if, over a period of time the amount of blood sucked overtakes the rate of production of red blood cells (RBC). This depends upon a fine balance between different variables in the host and parasite which are summarised in Image 1.
Based on these values a review concluded that there will not be clinically significant blood loss. However, mathematical modelling using differential equations suggests that anaemia can occur over approximately 6 years in untreated severe infestation.
Conclusion: Anaemia due to head lice is unlikely, in an otherwise healthy child. However untreated, prolonged and severe infestation might lead to anaemia in the long term.
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Anjay, M., Palanivel, V., Datta, V. et al. 1284 Human Pediculosis and Anaemia: A “Lousy” Association. Pediatr Res 68 (Suppl 1), 636 (2010). https://doi.org/10.1203/00006450-201011001-01284
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DOI: https://doi.org/10.1203/00006450-201011001-01284