Abdominal aortic thrombosis secondary to reactive thrombocytosis in a patient with iron deficiency anemia

Raso, Simona; Napolitano, Mariasanta; Saccullo, Giorgia; Siragusa, Sergio

doi:10.1007/s00277-016-2715-x

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…5 Secondary thrombocytosis can lead to severe and even lethal arterial visceral thrombosis. 6 Our patient did not have these causes and had bone marrow abnormalities. Hypertension and cigarette smoking are risk factors for development of thrombosis in patients with ET.…”

Section: Discussionmentioning

confidence: 64%

A case of simultaneous acute cardio-cerebral infarction in a woman with essential thrombocythemia

et al. 2019

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Essential thrombocythemia (ET) can cause arterial embolism. Patients with arterial thrombosis usually have additional risk factors, such as smoking and hypertension. We report a 70-year-old woman with ET who had no risk factors, except for age. Cranial magnetic resonance imaging showed fresh lacunar infarction in several lobes. Electrocardiography showed ST-segment elevation in leads II, III, and aVF. Coronary angioplasty and stenting were successfully performed. We checked the bone marrow and performed genetic testing. The Janus kinase 2 (JAK2) V617F gene mutation was found. This case was a rare initial presentation of previously undiagnosed ET with embolism of cardiovascular and cerebral vessels. Anti-platelet drugs and hydroxyurea were used to prevent further thrombosis in the coronary and cerebral arteries.

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Section: Discussionmentioning

confidence: 64%

A case of simultaneous acute cardio-cerebral infarction in a woman with essential thrombocythemia

et al. 2019

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“…Iron deficiency has also been shown to be associated with thrombosis, likely due to increases in platelet count (PLT) and agglutination capacity [4][5][6]. Thrombocytosis due to iron deficiency is thought to be reactive [7], and both arterial and venous thrombosis has been reported in iron deficiency [8,9]. In a study of 6 million patients, Song et al [10] reported that 32.6% of patients with iron deficiency anemia had thrombocytosis and 15.8% of patients with iron deficiency anemia and thrombocytosis had thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Threshold of Serum Ferritin to Discriminate against Those at Greater Risk of Platelet Increase during Treatment with Hypoxia-Inducible Factor Prolyl Hydroxylase Domain Inhibitor

Ogawa¹,

Tsuchiya

Tomosugi

et al. 2022

Acta Haematol

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Introduction: Hypoxia-inducible factor prolyl hydroxylase domain inhibitors (HIF-PHI) are a new treatment for renal anemia. HIF-PHI is believed to increase iron usage to improve availability of iron for erythropoiesis. Therefore, there is concern that HIF-PHI might be prone to iron deficiency and that thrombosis might be induced by increased platelet and transferrin levels due to this iron deficiency. Methods: Relationship of iron-related factors with platelet count (PLT), and total iron-binding capacity (TIBC; which reflects the transferrin level) were examined in 29 patients who were treated with darbepoetin alfa (DA) and then switched to roxadustat (Rox). To determine how changes in PLT and TIBC related to changes in iron-related factors, univariable and multivariable linear regression models were applied. To examine what iron-related factors on Day 0 influenced change in PLT, we used receiver operating characteristic curves (ROC) and logistic regression analysis for a rate of change in PLT ≤ 0% as the endpoint. Logistic regression analysis was performed with the reference group having serum ferritin (s-ft) or TSAT below the corresponding cutoff value (low vs high). Results: Multivariable analysis showed significant positive correlations between the rate of change in PLT and the change in serum ferritin (s-ft) and red blood cells (RBC) count [β-coefficients; 0.40 (95% conﬁdence interval [CI]: 0.17 to 0.62), P = 0.001], [β-coefficients; 30.45 (95% CI: 10.90 to 50.00), P = 0.004]. The rate of change in TIBC was significantly positively correlated with only the change in RBC count. The ROC showed a significant cutoff value for s-ft of 77.2 ng/mL (sensitivity 63.6%, specificity 83.3%, area under the curve 0.76, 95% CI 0.55–0.96). Multivariable logistic regression also showed that only high s-ft was significantly elevated (9.46, 95% CI 1.42–63.30, P = 0.020). Conclusions: This study showed that changes in PLT were correlated with s-ft and amount of hematopoiesis. This suggests that an increase in PLT due to iron levels is less likely when s-ft is 77.2 ng/mL or higher at the time of switching from DA to Rox. In contrast, TIBC was only related to hematopoiesis in these patients. Control of s-ft before initation of HIF-PHI treatment and gradual hematopoiesis might reduce the risk of thrombosis when switching from erythropoiesis-stimulating agents (ESAs) to HIF-PHI.

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“…The thrombotic and hemorrhagic risks associated with primary thrombocytosis ranged from 3.8 to 23.7% and 23.7% to 36% while in secondary thrombocytosis it was ranging from 0 to 14% and 3.03 to 4% respectively [2,[11][12][13][14][15]. Though it is evident from the above studies that the percentage of population developing risks was comparatively lower in the reactive thrombocytosis group when compared to primary thrombocytosis, this needs to be re-explored in the coming days as the number of reports highlighting the risks associated with secondary thrombocytosis are increasing [16][17][18][19][20][21][22][23]. The incidence of thrombotic episodes ranged from 22% to 63% and the incidence of bleeding episodes from 11% to 21% in patients with thrombocythemia [24].…”

Section: Discussionmentioning

confidence: 99%

The role of thrombocytapheresis in the management of extreme thrombocytosis: a 6 years’ experience from a tertiary care center

Chenna

Polavarapu

Kandasamy

et al. 2021

Medicine and Pharmacy Reports

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Background. According to the American Society for Apheresis (ASFA) guidelines, thrombocytapheresis is a Category II indication in symptomatic patients and is a Category III indication when used as secondary or prophylactic treatment. The role of thrombocytapheresis is to prevent untoward complications that might occur even before the cytoreductive agents can exert their action. Methods. A retrospective analysis of patients who underwent thrombocytapheresis between 2012 to 2018 was conducted. Demographic details, complete blood counts, diagnosis and indication for thrombocytapheresis were noted. Results. A total of 12 patients with thrombocytosis were included in the study. The cause of thrombocytosis was primary in 3 (25%) patients and secondary in 9 (75%) patients. The average percentage reduction in platelet count was 47.1% (range 12.3%-65.64%). There was a significant decrease in platelet count, platelet crit, and mean platelet volume after the procedure when compared to pre-procedure. Conclusion. Thrombocytapheresis selectively reduces platelet counts with no effect on other cellular and plasma components. The role of thrombocytapheresis in extreme thrombocytosis is to be considered for an immediate decrease in platelet count and to minimize the risks associated with thrombocytosis.

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Abdominal aortic thrombosis secondary to reactive thrombocytosis in a patient with iron deficiency anemia

Cited by 9 publications

References 9 publications

A case of simultaneous acute cardio-cerebral infarction in a woman with essential thrombocythemia

A case of simultaneous acute cardio-cerebral infarction in a woman with essential thrombocythemia

Threshold of Serum Ferritin to Discriminate against Those at Greater Risk of Platelet Increase during Treatment with Hypoxia-Inducible Factor Prolyl Hydroxylase Domain Inhibitor

The role of thrombocytapheresis in the management of extreme thrombocytosis: a 6 years’ experience from a tertiary care center

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