Project nEU-Med. The Contribution of Isotopic Analysis in the Differential Diagnosis of Anemia, the Case of the Medieval Cemetery of Vetricella (Scarlino, GR) in Tuscany

Pathological conditions in skeletal remains, such as cribra orbitalia and porotic hyperostosis, can be caused by etiologically different forms of anemia: hereditary hemolytic anemias, iron deficiency anemias, megaloblastic anemias, etc. Though not always simple to apply, differential diagnosis of cases of anemia found in the archaeological record is essential to correlate the pathology with the wider environmental and socio-cultural context.Anthropological analysis of the skeletal sample from the archaeological site of Vetricella showed a very high prevalence of cribra orbitalia and porotic hyperostosis. The differential diagnosis between acquired and congenital anemia is essential in the study of this condition, especially considering the presence of Plasmodium falciparum in this area and its role in the possible subsequent spread of the thalassaemia gene, which was widespread until a few decades ago.Carbon and nitrogen stable isotope analysis was carried out on a large subset of the skeletal sample, including both anemic and non-anemic individuals, to investigate the nutritional patterns of the Vetricella population in order to verify whether the widespread traces of anemia might be of dietary origin.Isotope results allowed for the exclusion of the hypothesis of nutritional-deficiency anemia and supported the hypothesis of congenital anemia.