Anemia can be caused by all kinds of things. It can be congenital, for example, or by a diet lacking vitamins (particularly iron, vitamin B-12, folate, and copper). But sometimes, just sometimes, it's because there's a nightmare leech lodged in your esophagus which is draining all your blood.
That was the scenario one doctor was recently faced with while treating a 3-year-old patient. Dr Jason Brotherton, who works in Kenya, shared an image on Monday of a leech he had taken from the patient who had a hemoglobin level of 3 g/dL. Normal levels in infants are around 9.5 to 13 g/dL.
"Before today, I felt pretty confident that I had encountered most causes of anemia until this was pulled from the upper esophagus of a 3-year-old," he wrote on Twitter, adding the alarming sentence "they've been feeding it for a while".
It's not clear when the child became leech food, though the doctor has theories.
"I imagine the leech was ingested several months ago," he wrote on Twitter. "The patient started with epistaxis that progressed to three months of cough. They finally coughed so hard that mom saw something in the back of the throat. Had to be removed via endoscopy because it was attached."
The child had swallowing issues, given that there was a large parasite living in her food pipe. However, following treatment, the patient was thankfully ok and returned home the day after having the leech removed.
Counter to what has been believed for around 2,500 years, letting a parasite remove your blood from your body is what's known as "not a great idea".
In ancient medicine, leeches were used to remove blood in order to treat everything from hemorrhoids to blood loss. As the scientific method was applied, it was found to not be effective (and actively harmful, given the risk of infection) for the large part. However, it is still used today for specific purposes, for which medical leeches are grown.
"In medicine, particularly plastic and reconstructive surgery, leeches may be used to help improve blood flow in an area of tissue or a skin flap that has poor blood circulation," the National Health Service (NHS) of the UK write on their website.
"Leeches do this by removing clotted blood (congested blood) from delicate areas, such as underneath a flap of skin or on a finger or toe."
But even the most foolhardy of doctors in ancient times would likely not recommend allowing a leech to set up home in your esophagus.