Abstract:
Background: Iron deficiency anaemia is the most commonly encountered form of anaemia in females worldwide. This form of
anaemia is, amongst others, associated with geophagia that is defined as the consumption of soil. The two main reasons for the
association of geophagia with anaemia are that soil is thought to supplement mineral deficiency and geophagia is seen as a symptom
of the anaemia. However, it is hypothesised that soil consumption interferes with iron absorption instead of supplementing it. The first
line of therapy for iron deficiency anaemia is oral iron. Therefore, if soil consumption interferes with iron absorption it could interfere
with oral iron therapy leading to patients being burdened with symptoms of anaemia as treatment is not effective. The aim of the
study was to evaluate the efficacy of oral iron therapy in female participants afflicted with iron deficiency anaemia associated with
geophagia.
Methods: In this prospective randomised intervention study, 84 geophagic women with iron deficiency anaemia were divided into
two groups. One group continued with soil consumption while the other stopped consumption. Oral iron therapy was administered
for ten weeks at increasing therapy doses for both groups. Red cell and iron study parameters were evaluated at different time intervals
to ascertain the efficacy of iron replacement therapy.
Results: The group that stopped soil consumption showed a statistically significant change in haemoglobin (9.4 to 10.0 g/dL,
p = 0.029), mean corpuscular volume (73.6 to 75.7 fl), mean corpuscular haemoglobin (23.7 to 24.6 pg), serum iron (22.5 to 28 μg/dL,
p < 0.001, transferrin saturation (4.8 to 6.9%, p < 0.001) and total iron-binding capacity (467 to 441 μg/L, p = 0.001). These findings
were contrary to the group that continued with consumption, where the statistical changes were only observed for the iron study
parameters (serum iron: 21 to 28 μg/dL, p = 0.038; transferrin saturation: 4.3 to 6.9%, p = 0.011; total iron-binding capacity: 496 to
421 μg/L, p = 0.002). Nevertheless, the changes for both groups were clinically insignificant. Oral iron therapy did not correct the
anaemia in geophagic females of both groups, this could be explained by two hypotheses where soil affected the gastrointestinal
lining and soil directly interfered with therapy iron absorption. This is evidenced by the group that continued with consumption
showing fewer changes than the group that abstained from soil consumption. These results were consistent with a case study where
oral iron therapy was implemented.
Conclusion: Oral iron therapy was not effective in geophagia cases of iron deficiency anaemia.
