| Hematological alterations in adolescent girls with restrictive
anorexia nervosa and secondary amenorrhea at the time of
diagnosis |
Katarina Sebekova1 
, Alexandra Gaál Kovalč2
, Ľubica Tichá2, Ľudmila Podracká2
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1Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
2Department of Pediatrics, Faculty of Medicine, National Institute of Children's Diseases, Comenius University, Bratislava, Slovakia |
Correspondence:
Katarina Sebekova, Email: sebekova3@uniba.sk
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Received: 4 April 2026 • Revised: 11 August 2026 • Accepted: 13 August 2026 |
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| Abstract |
Background
Anorexia nervosa (AN) is associated with
chronic energy deficiency and endocrine adaptations
affecting multiple organ systems involving bone metabolism
and hematological homeostasis. However, early
alterations in peripheral blood counts of adolescents
with a clinically homogeneous AN phenotype remain insufficiently
characterized.
Purpose
To examine the differences in blood counts
and associated bone and endocrine parameters between
adolescent girls with newly diagnosed restrictive AN
and secondary amenorrhea and healthy age-matched
controls.
Methods
The study included 59 patients and 20 controls.
Hematological indices, anthropometric characteristics,
body composition, bone mineral status, bone turnover,
and endocrine status markers were compared, and a
multivariate analysis was used to identify the predictors of
blood counts.
Results
Compared to controls, patients had significantly
lower leukocyte, erythrocyte, and platelet counts (all P<
0.01), and 29% had cytopenia in at least one parameter.
Bone formation markers (osteocalcin, amino-terminal
propeptide of human procollagen type I, and alkaline
phosphatase) and key endocrine parameters (insulinlike
growth factor-1, estradiol, and free thyroxine) were
suppressed. These alterations were also observed in patients
with a normal bone mineral density and adequate
vitamin B12 and folate levels. A multivariate analysis identified
endocrine- and bone-related predictors of blood
counts in controls but no consistent pattern of predictors
in patients.
Conclusion
Adolescent girls with restrictive AN and
secondary amenorrhea demonstrated hematological alterations
at the time of diagnosis despite the absence of a
measurable skeletal impairment or micronutrient deficiency.
These findings suggest that a chronic energy deficiency
and endocrine adaptation are associated with early
disturbances in hematological homeostasis. Peripheral
blood count may represent an accessible clinical marker of
systemic disturbances. |
| Key Words:
Anorexia nervosa, Adolescents, Hematological
alterations, Bone mineral density |
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