Recurrent Severe Iron Deficiency Anemia and Thrombocytopenia in an Adolescent Male

Giordano, Lisa; Llanos-Chea, Alejandro; Monde, Alexandra; Mulinge, Ivy; Dighe, Dipti

doi:10.1097/mph.0000000000001162

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…HIV-related thrombocytopenia has been reported to cause excessive bleeding among females during pregnancy 49. Thus, thrombocytopenia could further increase the risk of anaemia and even aggravate anaemia owing to acute or chronic blood loss among PLHIV 3 50. In addition, this study found that hepatitis C was associated with an increased risk of severe anaemia, which could be explained by the significant side effects of therapy for hepatitis C 51…”

Section: Discussionmentioning

confidence: 76%

Prevalence of anaemia and the associated factors among hospitalised people living with HIV receiving antiretroviral therapy in Southwest China: a cross-sectional study

Cao

Long²,

Liang³

et al. 2022

BMJ Open

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ObjectivesTo estimate anaemia prevalence and the associated factors among hospitalised people living with HIV (PLHIV) receiving antiretroviral therapy (ART).DesignA cross-sectional study.SettingPLHIV receiving ART and hospitalised in a specialised hospital for infectious disease in Guizhou Province, Southwest China, between 1 January 2018 and 31 March 2021.ParticipantsA total of 6959 hospitalised PLHIV aged ≥18 years and receiving ART were included in this study.Primary and secondary outcome measuresAnaemia was diagnosed as a haemoglobin concentration <120 g/L for non-pregnant females and <130 g/L for males. Mild, moderate and severe anaemia were diagnosed as below the gender‐specific lower limit of normal but ≥110 g/L, 80–110 g/L and <80 g/L, respectively.ResultsThe prevalence of anaemia was 27.5%, and that of mild, moderate and severe anaemia was 9.2%, 12.2% and 6.1%, respectively. Results from multivariate logistic regression showed that females had increased odds of anaemia (adjusted OR (aOR)=1.60, 95% CI: 1.42 to 1.81) compared with males. Widowed or divorced inpatients (anaemia: aOR=1.26, 95% CI: 1.08 to 1.47; severe anaemia: aOR=1.52, 95% CI: 1.16 to 1.97) and thrombocytopenia inpatients (anaemia: aOR=4.25, 95% CI: 3.54 to 5.10; severe anaemia: aOR=4.16, 95% CI: 3.24 to 5.35) had increased odds of anaemia and severe anaemia compared with their counterparts. Hepatitis C was associated with increased odds of severe anaemia (aOR=1.80, 95% CI: 1.11 to 2.92).ConclusionsAnaemia was prevalent among hospitalised PLHIV. Female sex, those widowed or divorced, and thrombocytopenia were associated with increased odds of anaemia, and those widowed or divorced, thrombocytopenia and hepatitis C were associated with increased odds of severe anaemia. Determination of anaemia predictors, early detection and timely management of anaemia are crucial to prevent anaemia progression.

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Section: Discussionmentioning

confidence: 76%

Prevalence of anaemia and the associated factors among hospitalised people living with HIV receiving antiretroviral therapy in Southwest China: a cross-sectional study

Cao

Long²,

Liang³

et al. 2022

BMJ Open

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“…A total of 11 individual case reports and one case series (containing 9 patients) were found, which are summarized in Tables 1-4 [9][10][11][12][13][14][15][16][17][18][19]. The age of the patients in the study ranged between 15 and 42 years, and a female predominance was observed (a female-to-male ratio of approximately 3:1) ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Patient ethnicity Giordano et al [9] 2019 Male 16 African Bayhan et al [10] 2016 Female 15 NA Kahraman et al [11] 2016 Male 17 NA Cunha et al [12] 2015 Female 16 NA Lindgren et al [13] 2009 Male NA NA Ganti et al [14] 2007 Female 39 African American Taskapan et al [15] 2003 Female 37 NA Go et al [16] 2000 Female 30 NA Soff and Levin (case 1) [17] 1988 Female 17 NA Soff and Levin (case 2) [17] 1988 Female 17 NA Knizley et al [18] 1972 Male 42 Black Lioger et al (series) [19] 2016 1 male, 8 females NA NA Platelet at baseline Lowest platelet count Days to nadir Last platelet count Giordano et al [9] 40 k/μL 28 k/μL 5 169 k/μL Bayhan et al [10] 820 x 10 9 /L 48 x 10 9 /L 363 x 10 9 /L Kahraman et al [11] 340 x 10 3 /mcL 68 x 10 3 /mcL 7 159 x 10 3 /mcL Cunha et al [12] 424 x 10 9 /L 45 x 10 9 /L 8 666 x 10 9 /L Lindgren et al [13] NA NA NA NA Ganti et al [14] 127 x 10 3 /mcL 39 x 10 3 /mcL 2 181 x 10 3 /mcL Taskapan et al [15] 102,000/L 2,000/L 8 87,000/L Go et al [16] 426 x 10 9 /L 20 x 10 9 /L 8 NA Soff and Levin (case 1) [17] 168,000/mm 3 21,000/mm 3 6 683,000/mm 3 Soff and Levin (case 2) [17] 717,000/mm 3 105,000/mm 3 10 NA Knizley et al [18] 1,465,000/mm 3 37,000/mm 3 13 265,000/mm 3 Lioger et al (series) [19] 172 ± 133 x 10 9 /L (range: 102-434) 85% from baseline NA…”

Section: No Authors Year Of Publication Patient Gender Patient Age (Ymentioning

confidence: 99%

Iron-Induced Thrombocytopenia: A Mini-Review of the Literature and Suggested Mechanisms

Babikir¹,

Raza²,

Soliman³

et al. 2020

Cureus

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Anemia constitutes a major global health burden, and iron deficiency is the most common cause of it. Iron deficiency and replacement affect not only hemoglobin (Hb) levels but also other hematological parameters such as platelet count. In this mini-review, we explore thrombocytopenia as a side effect of iron replacement therapy. We searched for relevant articles published in English, and all case reports/series of iron-induced thrombocytopenia were collected and analyzed. A total of 11 case reports and one case series were found relating to very low Hb at a baseline level of 5.25 +/-2.2 g/dl and variable platelet count at baseline that dropped in 9 +/-3 days to an average of 121 +/-112 x 10 9 /L, which in most of the cases was self-corrected. The parenteral route was more commonly reported to be associated with thrombocytopenia, and discontinuation of therapy was needed in two patients. The mechanisms, prevalence, and clinical significance of thrombocytopenia associated with iron replacement are unknown; several effects of iron on the primary hematopoietic cells and stromal cell lines have been proposed, such as influence on common progenitors, effects on cytokines, and thrombopoietic effect of erythropoietin, which is directly affected by iron levels. Iron replacement can lead to significant thrombocytopenia. Further research is needed to describe the exact incidence, mechanism, and clinical significance of thrombocytopenia associated with iron supplementation.

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“…Five cases of iron deficiency anemia and thrombocytopenia reported in this article discussed and reported 6,[8][9][10][11][12][13][14][15][16][17][18] in Table 1 all presented with severe IDA (median 4.5 g/dL, range 1.6-6.9 g/dL) and thrombocytopenia (median 38Â10E9/L, range 7-100Â10E9/L), both improving with iron treatment, which makes another cause such as Idiopathic Thrombocytopenic Purpura unlikely. There is no relationship between the severity of the anemia and the severity of the thrombocytopenia.…”

Section: Resultsmentioning

confidence: 80%

“…A peak of the reticulocyte and the platelet count was seen around day 5 after parenteral iron treatment, while the reticulocyte count peaked around day 9 and the platelet count peaked around day 20 of oral iron treatment. 7 The patients discussed and reported 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 in Table 1 all presented with severe IDA (median 4.5 g/dL, range 1.6‐6.9 g/dL) and thrombocytopenia (median 38×10E9/L, range 7‐100×10E9/L), both improving with iron treatment, which makes another cause such as Idiopathic Thrombocytopenic Purpura unlikely. There is no relationship between the severity of the anemia and the severity of the thrombocytopenia.…”

Section: Resultsmentioning

confidence: 99%

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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Recurrent Severe Iron Deficiency Anemia and Thrombocytopenia in an Adolescent Male

Cited by 4 publications

References 16 publications

Prevalence of anaemia and the associated factors among hospitalised people living with HIV receiving antiretroviral therapy in Southwest China: a cross-sectional study

Prevalence of anaemia and the associated factors among hospitalised people living with HIV receiving antiretroviral therapy in Southwest China: a cross-sectional study

Iron-Induced Thrombocytopenia: A Mini-Review of the Literature and Suggested Mechanisms

Thrombocytopenia in severe iron deficiency anemia in children

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