Iron-Deficiency Anemia Leading to Transient Ischemic Attacks due to Intraluminal Carotid Artery Thrombus

Abstract

Reactive thrombocytosis secondary to iron-deficiency anemia (IDA) is a rare but recognized cause of stroke. We report the case of a patient with iron-deficiency anemia presenting with multiple transient ischemic attacks (TIA) due to intraluminal thrombus of an internal carotid artery. The putative mechanisms underlying anemia and stroke syndromes are not completely understood, and it is believed that iron deficiency may cause ischemic stroke by several potential mechanisms. Thrombocytosis is often associated with iron deficiency, and microcytosis produces a reduction in the red cell deformability and could produce a hypercoagulable state. The platelet count and function observed in iron-deficiency anemia could act synergistically to promote thrombus formation, especially in the setting of an underlying atherosclerotic disease. The presence of floating thrombus in a patient with clinical and MRI evidence of stroke represents a significant therapeutic dilemma and requires immediate decision about treatment.

Simultaneous Thrombosis in a Normal Left Ventricle and Normal Carotid Artery in a Patient With a Stroke Secondary to Iron Deficiency Anemia

“…The characteristics of our present patient, taken together with those of others [3][4][5][6][7][8][9][10][11], suggest that in patients with IDA, a thrombus may be formed proximally from the left ventricle to the carotid arteries. In view of Virchow's triad for thrombosis, it is surprising that a massive thrombus was formed in apparently intact large arteries such as the aorta or carotid where the blood flows without stagnation.…”

“…Moreover, when IDA is associated with stroke or a systemic embolism, large thrombi are sometimes present in an apparently intact carotid artery [3][4][5][6][7][8][9] as in our present case or less commonly in the aorta [10,11]. These patients are young women 20 -50 years of age with severe IDA (Hb 5.5 -10 g/dL), which is often caused by menorrhagia.…”

“…Moreover, several case reports suggest a causative role of IDA in young and otherwise healthy patients with stroke or with systemic embolism where thrombi are sometimes detected on an apparently intact arterial wall such as the carotid artery [3][4][5][6][7][8][9] or aorta [10,11]. Here we describe a patient with thrombi in an otherwise normal carotid artery and left ventricle, which is a previously unreported site for thrombosis in patients with IDA.…”

Severe anemia from heavy menstrual bleeding requires heightened attention

“…19 Iron deficiency produces important clinical problems, including fatigue, atrophic epithelial changes, oral lesions, dysphagia, nail lesions, and reduced immune response. 20,21 Severe iron deficiency has also been associated with acute ischemic stroke, [22][23][24] venous stasis, retinopathy, 25 and cerebral sinovenous thrombosis. 26 Both thrombocytopenia and reactive thrombocytosis have been associated with severe anemia.…”

Severe Anemia from Heavy Menstrual Bleeding Requires Heightened Attention

“…Excessive bleeding results in iron deficiency anemia, which in turn leads to serious medical problems and impacts women's quality of life and their utilization of medical care services [2][3][4][5][6][7][8][9]. Iron deficiency can manifest with fatigue, oral lesions, dysphagia, reduced immune response, ischemic stroke, venous stasis, retinopathy or cerebral sinovenous thrombosis.…”