The effect of iron balance on platelet counts in blood donors

Eder, Anne F.; Yau, Yu Ying; West, Kamille A.

doi:10.1111/trf.13881

Cited by 17 publications

(19 citation statements)

References 20 publications

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“…While administered iron therapy in the control group did not affect platelet counts. 4 These results indicate that there is an EPO‐independent link between iron deficiency and thrombocytosis. Xavier‐Ferrucio et al present experimental findings that support this hypothesis that low iron in the bone marrow, attenuates extracellular signal‐regulated kinase signaling, slow proliferation, and biases the commitment of megakaryocytic‐erythroid progenitors toward the megakaryocytic lineage in both human and mouse.…”

Section: Discussionmentioning

confidence: 87%

“…Rarely the thrombocytopenia presents a few days after the start of iron replacement therapy. While studies involving adults with IDA and thrombocytopenia have been reported, 4 , 5 , 6 data involving children is very limited. We present some unusual cases, provide an overview of related cases in the literature, and discuss the possible underlying etiology.…”

Section: Introductionmentioning

confidence: 99%

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Thrombocytopenia in severe iron deficiency anemia in children

Akker

Chielens²,

Lopes

et al. 2021

Health Science Reports

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Aim Iron deficiency anemia (IDA) is common in the pediatric population and often accompanied by mild thrombocytosis, but rarely profound thrombocytopenia is seen. We describe the data of children with IDA and thrombocytopenia in two centers and discuss the published data in the literature. Methods In this retrospective case series, the medical records of patients under the age of 19 years old diagnosed with IDA in two tertiary medical centers over the last 10 years, were reviewed. The data were collected and compared to the data published in the medical literature. Results All the patients presented with severe IDA and thrombocytopenia improved with iron treatment. Although none of the patients had signs of major bleeding, the thrombocytopenia could mostly be classified as severe (platelet count <50×10E9/L). Due to the severity of the anemia, in about half of the cases, a red blood cell transfusion was given. The peak of the platelet count was seen in the first month after the start of iron treatment. In eight cases of children with IDA, the thrombocytopenia appeared after the supplementation of iron was started. Conclusion Clinically stable children with severe IDA and thrombocytopenia, where other causes are very unlikely, warrant an empiric monotherapy with iron to prevent unnecessary investigations and treatments.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia in severe iron deficiency anemia in children

Akker

Chielens²,

Lopes

et al. 2021

Health Science Reports

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“…Similar ID-induced thrombocytosis is common in humans and iron replacement therapy has been shown to reduce PLT in various patient populations, from IBD, chronic kidney disease, or even in iron depleted blood donors 18,19,[26][27][28] .…”

Section: Discussionmentioning

confidence: 89%

Iron deficiency-induced thrombocytosis increases thrombotic tendency in rats

Jimenez

Leitner

et al. 2020

haematol

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Iron deficiency (ID) is globally prevalent, and apart from anemia is associated with thrombocytosis. While considered benign, studies linking thrombotic events with prior ID anemia suggest otherwise. Herein we used animal models to assess the influence of ID on thrombotic tendency. Sprague-Dawley rats were fed control or iron deficient diets and ferric carboxymaltose was used to reverse ID. Thrombosis was induced via stenosis of the inferior vena cava or damage to the right carotid artery using ferric chloride. Thrombi were evaluated histologically and via high frequency ultrasound in the venous model. ID consistently induced thrombocytosis alongside anemia. Venous thrombus growth and final dimensions in both arterial and venous thrombi were largest in ID. In both models, platelet numbers correlated with the final thrombus size, with ID thrombi having the largest platelet areas. Platelet function was also evaluated in surgically naïve rats. Coagulability on thromboelastography and hemostasis on tail transection were augmented in ID. Platelet and plasma Pselectin expression were both higher in ID. Platelet adhesion and aggregation in ID was impaired under shear flow but was intact on static assays. Iron replacement therapy reversed all ID-related changes in hematological parameters, thrombus dimensions, and platelet assays. In summary, ID alone increases thrombotic tendency. Iron replacement therapy reverses these changes, making it a viable strategy for prevention of ID-related thrombotic disease. This may be of importance in patients with chronic illnesses which may already be at increased risk for thrombosis such as inflammatory bowel disease, chronic kidney disease, or cancer.

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“…Our study finds that iron replacement therapy decreases mean platelet counts in premenopausal women with IDA to a similar extent as other IDA patient groups treated with iron replacement therapies. For instance, in a retrospective cohort of adult blood donors, Eder et al 7 observed a decrease in platelet count (−19.8 K/mm 3 ) in a subgroup analysis of female blood donors of any age with baseline ferritin <20 µg/L treated with oral iron. Recent studies have begun to investigate mechanistic underpinnings of these findings.…”

Section: Discussionmentioning

confidence: 99%

Platelet reactivity and platelet count in women with iron deficiency treated with intravenous iron

Elstrott

Lakshmanan

Melrose

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Background Iron deficiency anemia (IDA) and heavy menstrual bleeding are prevalent, interrelated issues impacting over 300 million premenopausal women worldwide. IDA is generally associated with increased platelet counts; however, the effects of IDA and its correction on platelet function in premenopausal women remain unknown. Objectives We sought to determine how IDA and intravenous iron affect platelet count and platelet function in premenopausal women. Methods Hematologic indices were assessed in a multicenter, retrospective cohort of 231 women repleted with intravenous iron. Pre‐ and postinfusion blood samples were then obtained from a prospective cohort of 13 women to analyze the effect of intravenous iron on hematologic parameters as well as platelet function with flow cytometry and platelet aggregation assays under physiologic shear. Results Following iron replacement, anemia improved, and mean platelet counts decreased by 26.5 and 16.0 K/mm3 in the retrospective and prospective cohorts, respectively. Replacement reduced baseline platelet surface P‐selectin levels while enhancing platelet secretory responses to agonists, including collagen‐related peptide and ADP. Platelet adhesion and aggregation on collagen under physiologic shear also significantly increased following repletion. Conclusion We find that intravenous iron improves anemia while restoring platelet counts and platelet secretory responses in premenopausal women with iron deficiency. Our results suggest that iron deficiency as well as iron replacement can have a range of effects on platelet production and function. Consequently, platelet reactivity profiles should be further examined in women and other groups with IDA where replacement offers a promising means to improve anemia as well as quality of life.

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The effect of iron balance on platelet counts in blood donors

Abstract: Iron-depleted donors had higher platelet counts than donors who had adequate iron stores. Oral iron replacement decreased platelet counts on average by about 20,000/µL in iron-depleted donors but had no effect on platelet counts in donors who had normal or stable ferritin levels.

Cited by 17 publications

References 20 publications

Thrombocytopenia in severe iron deficiency anemia in children

Thrombocytopenia in severe iron deficiency anemia in children

Iron deficiency-induced thrombocytosis increases thrombotic tendency in rats

Platelet reactivity and platelet count in women with iron deficiency treated with intravenous iron

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