Thrombocytosis in Iron Deficiency Anemia

Abstract

Background: Thrombocytosis can be a result of a reactive process such as acute blood loss, infections, iron deficiency anemia (IDA) or a clonal disorder such as Essential Thrombocythemia. The challenge of correctly identifying the etiology of thrombocytosis in an individual patient becomes particularly essential when the clinician is confronted with decisions regarding further workup, follow up as well as preventing future complications such as thrombotic events. Prior data linking iron deficiency anemia and thrombocytosis has been concluded from studies with small sample size, and to a large part, this association is based on anecdotal evidence. Our study examines the association between IDA and platelet counts and to the best of our knowledge is the largest study to do so. Methods: We performed a retrospective chart review of patients seen at our outpatient clinic from 1st January to 31st December 2017. We defined Iron deficiency as serum ferritin <30 mcg/dl, anemia in males as hemoglobin (Hb) <13.1 g/dl, anemia in females as Hb <11.7g/dl and thrombocytosis as platelet count >450,000/ul. Patient demographics, as well as hematological data, were collected and compared between three groups: Iron deficiency anemia, Iron deficiency without anemia, and control. We defined controls as subjects with neither iron deficiency nor anemia. Bivariate analysis using the Chi-square test for categorical variables, and a One-Way ANOVA for continuous variables were used to determine the association between the three groups of interest and the covariates. The relationship between platelet counts and other hematological parameters was evaluated using Pearson's correlation test. Results: Of the 4896 subjects included in our study, 1225 (25.02%) had iron deficiency anemia, 699 (14.28%) had iron deficiency without anemia, and 2972 (60.70%) were controls. The mean age of the cohort was 55.8 (SD = 18.31) years, and 73.9% of the subjects were females. In the IDA group, the mean hemoglobin was 10.21 (SD = 1.39) g/dl, the mean platelet count was 319.24 (SD = 106.92) k/uL, and 127 (10.37%) subjects had thrombocytosis whereas 1098 (89.63%) had normal platelet counts. When compared to the control group, 32 (1.08%) subjects had thrombocytosis, and 2940 ( 98.92%) had normal platelet counts. The difference in numbers of subjects with thrombocytosis between iron deficiency anemia, iron deficiency without anemia and control group was statistically significant as indicated by P<0.001 on the Chi-Square test. Furthermore, we found an inverse relationship between platelet count and ferritin as well as hemoglobin level with a p < 0.0001 across all groups. Conclusions: Our study demonstrated a significant association between iron deficiency anemia and thrombocytosis when compared to the control group however at a lower frequency than seen in the previously published studies. Further studies are needed to study causality and to elucidate the mechanism by which iron deficiency anemia leads to thrombocytosis. Table. Table. Disclosures No relevant conflicts of interest to declare.

Unsupervised machine learning algorithms identify expected haemorrhage relationships but define unexplained coagulation profiles mapping to thrombotic phenotypes in hereditary haemorrhagic telangiectasia

“…Unlike the earlier profiles, there was no significant difference in the patients’ ages, sex or clinical features for the combined iron and clotting profiles. The Profile 1 combination of lowest iron, T f SI and ferritin with highest platelet count is reminiscent of the data that thrombocytosis accompanies acute haemorrhage with iron deficiency anaemia shown to be associated with higher platelet counts [37,38]. Of note, within the combined iron and clotting profiles, all SMAD4 patients were within the iron‐deficient profile.…”

“…Clotting indices comprised platelet count, serum fibrinogen concentration, prothrombin time (PT) and activated partial thromboplastin time (APTT). Iron indices included serum iron, T f SI, ferritin and C‐reactive protein (CRP) as a known confounder (marker of inflammation that increases serum ferritin) [27, 37, 38].…”

Evaluation of Sarcopenia, Frailty, and Inflammation on Adverse Events and Survival Outcomes in Patients with Oral Cavity Squamous Cell Carcinoma under Adjuvant Chemoradiotherapy

“…Since disease-related blood loss can be encountered in OSCC, CRT can be immunosuppressive, inhibiting erythropoiesis and gastrointestinal mucositis, resulting in further nutritional status deterioration. Chronic malnutrition may strengthen anemia severity, such as via folic acid and iron insufficiency [ 40 ]; this may also be partly caused by alcohol consumption in most of our patients. Consistent with a previous study [ 10 , 36 ], sarcopenia may be a more accurate marker for nutritional status than BMI.…”

“…Moreover, we found that PLR was a predictor of CIA. Thrombocytosis can result from reactive processes such as acute blood loss, infections, and iron deficiency anemia [ 40 , 41 ]. However, further research is still required to show an effect between PLR and the cause of anemia during CRT in patients with OSCC.…”

A Study on Risk Factors and Clinical Profile of Anemia Among Children Aged 6 Months–60 Months at a Tertiary Care Center in Tamilnadu

“…Thrombocytosis was associated with severe anemia in 32.7% of children in the present study. This is explained by reactive thrombocytosis to iron deficiency anemia where erythropoietin stimulates thrombopoietin receptors and thus megakaryocytes [15].…”