Acute ischemic stroke as initial manifestation of undiagnosed iron deficiency anemia: case-report and literature review

Awad, Dana; Kousa, Omar; Essa, Amr; Kuniyoshi, Jason; Kousa, Hamza; Qasim, Abdallah; Andukuri, Venkata; Kassim, Thamer

doi:10.21037/acr-20-72

Cited by 6 publications

(13 citation statements)

References 18 publications

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“…In comparison, the population’s most frequently described are often adults or children with predisposing conditions for thrombosis. 2,5-7 A recent report from Cohen et al 5 involved a fatal stroke in a 2-year-old female who was found to have severe IDA (Hgb 2.3 g/dL, MCV 52.7 fL, serum iron 15 mg/dL) similar to our case. 5 Unlike our patient, this child’s laboratory results also revealed evidence of disseminated intravascular coagulation and decreased serum concentrations of protein C&S, both predisposing conditions for thrombosis.…”

Section: Discussionsupporting

confidence: 78%

Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient

Gonzalez,

Hanna,

Shah

et al. 2023

Clin Pediatr (Phila)

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Section: Discussionsupporting

confidence: 78%

Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient

Gonzalez,

Hanna,

Shah

et al. 2023

Clin Pediatr (Phila)

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“…reactive thrombocytosis, hypercoagulable state, hyperkinetic state), disturbing endothelial adhesion, causing acute hypoxia. [6][7][8][9][10][11][12][13][14] Our findings as described in Case 2 support the evidence of an association between anaemia and ischaemic events. Vascular conditions such as the moyamoya disease can also play a role.…”

Section: Diagnosis Is Established By Observing the Morphology Of Rbcs...supporting

confidence: 83%

“…6 Besides, anaemia severity can be conditioned by other factors, such as its association with sickle cell, beta-thalassemia or iron deficiency. [6][7][8][9][10][11][12][13][14] Prevalence of iron-deficiency anaemia is growing and has been proved to be the most common blood disorder in the infant population. 11 There are reports of chronic anaemia by iron deficiency resulting in strokes.…”

Section: Diagnosis Is Established By Observing the Morphology Of Rbcs...mentioning

confidence: 99%

Hereditary elliptocytosis: A novel mutation in the SPTA1 gene and diagnosis after a stroke in paediatric patients. A two‐case report

Toro

Belmonte

García

et al. 2023

Pediatric Blood & Cancer

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“…However, previous studies investigating the association of iron deficiency with PLT, elevated TIBC, and thrombosis used serum iron (s-Fe) less than 20 μg/dL and s-ft less than 10 ng/mL as criteria for severe iron deficiency. And in those reports, mean PLT was 326-550.6 (×10 3 /μL) [18][19][20]. It is difficult to determine how much PLT level is prone to thrombosis during HIF-PHI treatment.…”

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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Acute ischemic stroke as initial manifestation of undiagnosed iron deficiency anemia: case-report and literature review

Cited by 6 publications

References 18 publications

Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient

Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient

Hereditary elliptocytosis: A novel mutation in the SPTA1 gene and diagnosis after a stroke in paediatric patients. A two‐case report

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

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