Iron-induced thrombocytopenia in severe iron-deficiency anemia

Abstract

Iron deficiency anemia (IDA) is commonly associated with reactive thrombocytosis, but thrombocytopenia is relatively uncommon and generally associated with more severe IDA. Even more rarely described has been thrombocytopenia following iron replacement therapy to treat IDA, and the underlying mechanism remains unclear. The authors present the case of a patient with severe IDA, who developed thrombocytopenia after the initiation of iron therapy. An analysis is made of all the previous reports of similar cases, to compare and start on the path of understanding this rare entity.

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

“…A total of 11 individual case reports and one case series (containing 9 patients) were found, which are summarized in Tables 1-4 [9][10][11][12][13][14][15][16][17][18][19]. The age of the patients in the study ranged between 15 and 42 years, and a female predominance was observed (a female-to-male ratio of approximately 3:1) ( Table 2).…”

“…Patient ethnicity Giordano et al [9] 2019 Male 16 African Bayhan et al [10] 2016 Female 15 NA Kahraman et al [11] 2016 Male 17 NA Cunha et al [12] 2015 Female 16 NA Lindgren et al [13] 2009 Male NA NA Ganti et al [14] 2007 Female 39 African American Taskapan et al [15] 2003 Female 37 NA Go et al [16] 2000 Female 30 NA Soff and Levin (case 1) [17] 1988 Female 17 NA Soff and Levin (case 2) [17] 1988 Female 17 NA Knizley et al [18] 1972 Male 42 Black Lioger et al (series) [19] 2016 1 male, 8 females NA NA Platelet at baseline Lowest platelet count Days to nadir Last platelet count Giordano et al [9] 40 k/μL 28 k/μL 5 169 k/μL Bayhan et al [10] 820 x 10 9 /L 48 x 10 9 /L 363 x 10 9 /L Kahraman et al [11] 340 x 10 3 /mcL 68 x 10 3 /mcL 7 159 x 10 3 /mcL Cunha et al [12] 424 x 10 9 /L 45 x 10 9 /L 8 666 x 10 9 /L Lindgren et al [13] NA NA NA NA Ganti et al [14] 127 x 10 3 /mcL 39 x 10 3 /mcL 2 181 x 10 3 /mcL Taskapan et al [15] 102,000/L 2,000/L 8 87,000/L Go et al [16] 426 x 10 9 /L 20 x 10 9 /L 8 NA Soff and Levin (case 1) [17] 168,000/mm 3 21,000/mm 3 6 683,000/mm 3 Soff and Levin (case 2) [17] 717,000/mm 3 105,000/mm 3 10 NA Knizley et al [18] 1,465,000/mm 3 37,000/mm 3 13 265,000/mm 3 Lioger et al (series) [19] 172 ± 133 x 10 9 /L (range: 102-434) 85% from baseline NA…”

The effect of iron balance on platelet counts in blood donors

“…Many (but not all) adult patients with iron‐deficiency anemia in those series had gastrointestinal bleeding or other identified sources of ongoing, chronic blood loss . Less commonly, thrombocytopenia (< 150 × 10 3 platelets/µL) has been reported in patients with severe iron‐deficiency anemia, either at their initial presentation or early in the response to iron therapy . The association of abnormal platelet counts with iron deficiency, however, largely depends on the patient population .…”

Iron and platelets: A subtle, under‐recognized relationship

“…It should be noted, however, that variations of both hepcidin and ferritin levels remained minimal. Thrombocytopenia can be observed in severe iron deficiency, and clinicians should be aware of this rare event (less than 50 reported cases 55,[63][64][65][66] ). It can be falsely diagnosed as an immune thrombocytopenia that can be associated with iron deficiency secondary to bleeding.…”