What is the role of a complete blood count (CBC) with erythrocyte sedimentation rate (ESR) in the workup of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Obtain a CBC with erythrocyte sedimentation rate (ESR). The hemoglobin levels are typically normal, although elevations are observed in states of dehydration. If anemia is observed, it is not due to menstrual blood loss, as these patients are usually amenorrheic. In such cases, further investigation is warranted.

The white blood cell (WBC) count is typically low due to increased margination, and thrombocytopenia is also observed. The leukopenia is not a sign that the patient is at an increased risk for infection.

The ESR is normal in anorexia nervosa. Therefore, elevations should prompt a search for an organic etiology, such as neuropsychiatric involvement including affective disorders, psychosis, cognitive dysfunction, and steroid-induced anorexia nervosa in adolescents with systemic lupus erythematosus (SLE), which may be triggered by steroid-induced changes in weight and body shape. Anorexia nervosa may be a presentation of neuropsychiatric SLE; thus, patients with anorexia nervosa who have joint symptoms, a positive antinuclear antibody, or lymphopenia should be investigated and followed for possible SLE, especially as treatment of the SLE may be associated with recovery from anorexia nervosa. [96]

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