Triad of Iron Deficiency Anemia, Severe Thrombocytopenia and Menorrhagia–-A Case Report and Literature Review

Abstract

Introduction Thrombocytosis is a common disorder in patients diagnosed with iron deficiency anemia. The decreased platelet counts commonly found iron deficiency anemia is rarely reported in clinical practice. The exact mechanism of the occurrence of thrombocytopenia in iron deficiency anemia remains unclear. In this case report we discuss a triad of symptoms seen in the African American population: Iron deficiency anemia, menorrhagia and thrombocytopenia. Case presentation A 40 year old multiparous African-American woman presented with heavy vaginal bleed, severe anemia (3.5 g/dL) and thrombocytopenia (30,000/mm3). The peripheral blood smear showed marked microcytic hypochromic cells with decreased platelets counts. After excluding other causes of thrombocytopenia and anemia, increased red cell distribution width and low iron saturation confirmed the diagnosis of iron deficiency anemia. Treatment for iron deficiency anemia was initiated with intravenous and oral iron supplements. Two months following treatment of iron deficiency anemia, the triad of manifestations resolved and patient remained stable. Conclusion Profound degree of iron deficiency anemia can present with thrombocytopenia and severe menorrhagia. Iron replacement should be the main treatment goal in these patients. This case report further supports the 2 compartment model of the role of iron in maintaining platelet counts.

A simple and feasible questionnaire to estimate menstrual blood loss: relationship with hematological and gynecological parameters in young women

“…The fact that women with lower MBL presented higher platelet count, although is in agreement with few case reports in iron deficiency anemic women with menorrhagia [23,24], contrasts with the usual diagnosis of thrombocytosis in iron deficiency anemia [25]. In the present study volunteers were healthy, non-anemic and all their hematological and biochemical values including platelets were within normal ranges and it was observed that hormonal contraceptive use had a confounding influence.…”

Cerebral Venous Thrombosis in a Patient with Iron Deficiency Anemia and Thrombocytopenia: A Case Report

“…Unlike children, in which the major cause of IDA is insufficient dietary iron intake, chronic blood loss is the most common cause of IDA in adults especially in women with menstrual irregularities as was seen in our patient who suffered from menorrhagia. The resolution of severe symptomatic anaemia along with thrombocytopenia following iron supplementation strengthens the hypothesis that iron therapy plays an important role in improving thrombocytopenia associated with IDA [ 13 ].…”

Severe anemia from heavy menstrual bleeding requires heightened attention

“…26 Both thrombocytopenia and reactive thrombocytosis have been associated with severe anemia. [27][28][29] One in 3 US women undergoes a hysterectomy before age 60 years; in half of these women, the primary presenting problem is heavy menstrual bleeding. 30 It is not clear that women themselves reliably recognize that their bleeding is excessive and that it places themselves at risk for such serious health consequences.…”