S4123 A Not-So-Healthy Dose of Turmeric: An Unusual Cause of Iron Deficiency Anemia

Introduction: Iron deficiency anemia (IDA) is a common condition with a broad differential, including dietary insufficiency, malabsorption, and chronic blood loss. We present a case of recurrent, transfusion-dependent anemia in a young patient due to both dietary and anatomic factors. Case Description: A 33-year-old man with a 2-year history of anemia presented with generalized weakness. Over the prior 2 years, he required intermittent packed red blood cell (pRBC) transfusions and iron infusions. At that time, he refused endoscopic work-up. His anemia was attributed to consumption of several cups of dry matcha powder daily, which he replaced with turmeric after adopting a vegan diet. He denied melena, hematemesis, hematochezia, or bright red blood per rectum. On admission, labs revealed hemoglobin (Hgb) 4.9, MCV 62.1, BUN 9, serum iron 7, TIBC 310, ferritin 3.9, reticulocyte index 0.33, total bilirubin 0.3, LDH 162, haptoglobin 144, and negative celiac serologies. Abdominal computed tomography with contrast was unremarkable. Bidirectional endoscopy showed duodenal mucosal lymphangiectasia and diverticulosis. He received 2 pRBCs, with an appropriate rise in Hgb to 7.4. He completed a 3-day course of intravenous iron sucrose and was discharged on oral iron. Over the following 6 months, he had 3 more admissions with Hgb less than 5. He reported continued turmeric consumption and noncompliance with iron. Due to recurrent hospitalizations, inpatient video capsule endoscopy (VCE) was pursued, revealing an active small bowel bleed with 34% small bowel transit time. Push enteroscopy was unrevealing. He received a transfusion, dietary counseling, and was discharged with follow-up with an advanced endoscopist for balloon enteroscopy, though this was never performed. After strict turmeric cessation and adherence to nutritional guidance, his Hgb improved to 12.6, with no further transfusion needs. Discussion: This case highlights a multifactorial etiology of IDA, in which dietary factors, particularly excessive turmeric intake, played a central role. Curcumin, the active compound in turmeric, impairs iron absorption by chelating iron and inhibiting gastrointestinal angiogenesis. This may have contributed to the patient's small bowel bleed and help explain why an otherwise healthy young patient developed a small bowel bleed without an identifiable source. His vegan diet likely further contributed to his iron deficiency, emphasizing the importance of a thorough dietary history and nutritional counseling in managing IDA.