For patients with eating disorders, hematologic abnormalities may be associated with reductions in body weight, according to a retrospective analysis published in the American Journal of Hematology.

The study involved an evaluation of medical records from 921 patients who had been admitted to the Eating Recovery Center in Denver, Colorado. Patients were stratified into 3 groups that included bulimia nervosa (BN; 123 patients) and subtypes of anorexia nervosa (AN), including the restricting form (AN-R; 415 patients) and the binge-eating/purging form (AN-B/P; 383 patients). The researchers evaluated patient information collected at the time of admission, including patient weight and hematologic parameters.

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In this study, patients’ eating disorders had lasted an average of 11.3 years. On admission, patients with BN had an average body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 20.8, while patients with AN had an average BMI of 15.5.

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Anemia occurred at rates of 20.2% in the AN-B/P group, 16.4% in the AN-R group, and 11.2% in the BN group. Thrombocytopenia rates were 7.4% in the AN-R group, 5.2% in the AN-B/P group, and 1.7% in the BN group.

Leukopenia was relatively common with anorexia, appearing in 50.5% of patients with AN-R and 36.8% of patients with AN-B/P, compared with 17.2% of patients with BN. The researchers found an association between BMI and low white blood cell count (Pearson correlation coefficient, 0.31; P <.001).

Microcytosis occurred at a relatively low level among patients in this study. Macrocytosis was more common among patients in this study, occurring in 6.9% of those with AN-R, 5.8% of those with AN-B/P, and 2.6% of those with BN. The researchers noted that in this study, all patients with AN who had macrocytosis also had anemia.

The researchers considered most hematologic abnormalities present in this study to be related to malnutrition, which was more pronounced in patients with AN. “The extent of hematologic abnormalities in AN depends on the severity of caloric deprivation, such that resumption of intake and weight gain are generally all that is needed for both serum and marrow abnormalities to normalize,” the researchers wrote.


1.     Walsh K, Blalock DV, Mehler PS. Hematologic findings in a large sample of patients with anorexia nervosa and bulimia nervosa [published online January 15, 2020]. Am J Hematol. doi:10.1002/ajh.25732