Iron-Induced Thrombocytopenia: A Mini-Review of the Literature and Suggested Mechanisms

Abstract

Anemia constitutes a major global health burden, and iron deficiency is the most common cause of it. Iron deficiency and replacement affect not only hemoglobin (Hb) levels but also other hematological parameters such as platelet count. In this mini-review, we explore thrombocytopenia as a side effect of iron replacement therapy. We searched for relevant articles published in English, and all case reports/series of iron-induced thrombocytopenia were collected and analyzed. A total of 11 case reports and one case series were found relating to very low Hb at a baseline level of 5.25 +/-2.2 g/dl and variable platelet count at baseline that dropped in 9 +/-3 days to an average of 121 +/-112 x 10 9 /L, which in most of the cases was self-corrected. The parenteral route was more commonly reported to be associated with thrombocytopenia, and discontinuation of therapy was needed in two patients. The mechanisms, prevalence, and clinical significance of thrombocytopenia associated with iron replacement are unknown; several effects of iron on the primary hematopoietic cells and stromal cell lines have been proposed, such as influence on common progenitors, effects on cytokines, and thrombopoietic effect of erythropoietin, which is directly affected by iron levels. Iron replacement can lead to significant thrombocytopenia. Further research is needed to describe the exact incidence, mechanism, and clinical significance of thrombocytopenia associated with iron supplementation.

Thrombocytopenia in severe iron deficiency anemia in children

“…Reports of thrombocytopenia after the start of iron replacement therapy, are extremely rare. 35 In general, the platelet count returns to normal regardless of whether the iron therapy is interrupted or not. The timing of the appearance of thrombocytopenia after the start of iron therapy is variable, as well as normalization of the thrombocyte count and is unrelated to the method of iron administration (see also Table 1 ).…”

“…Reports of thrombocytopenia after the start of iron replacement therapy, are extremely rare. 35 In general, the platelet count returns to normal regardless of whether the iron therapy is interrupted or not.…”

Iron Therapy-Induced Leukopenia in Arab Female Population, an experience in Qatar

“…One review of 11 case reports and a case series described that thrombocytopenia can be induced by iron replacement (ferrous sulphate). (12) Brito-Babapulle et al reported a case of fatal bone marrow suppression linked to ferric carboxymaltose therapy in a patient with IDA. This case started as amegacaryocytic thrombocytopenia and erythroid cell aplasia which was followed by a drop in neutrophils count.…”

Thrombocytopenia secondary to iron deficiency anemia responding to iron therapy

“…About 29% of all women of reproductive age have anemia globally 1 . Approximately 50% of cases of anemia are considered to be due to iron deficiency, but the proportion probably varies among population groups and in different areas 2 …”

“…1 Approximately 50% of cases of anemia are considered to be due to iron deficiency, but the proportion probably varies among population groups and in different areas. 2 The anemia cutoffs vary based on age, sex, and pregnancyspecific (Table 1). Severe anemia is defined by WHO as Hb < 70 g/L in pregnant women and children under 5 years of age and Hb < 80 g/L in all other age groups.…”