Severe Thrombocytopenia With Iron Deficiency Anemia

Abstract

Objective Although severe thrombocytopenia has been reported among children with iron deficiency anemia, the presence of both anemia and thrombocytopenia can suggest serious or malignant bone marrow dysfunction, requiring further work-up. This paper reviews the management and outcomes of patients with the diagnosis of iron deficiency anemia presenting with severe thrombocytopenia. Methods We present four pediatric patients with iron deficiency anemia and severe thrombocytopenia at initial presentation. Charts were reviewed after approval by the institutional review boards at both St. Jude Children’s Research Hospital and LeBonheur Children’s Medical Center in Memphis, Tennessee. Results and Conclusions All four patient’s hemoglobin concentrations and platelet counts normalized within one to three weeks of initiating iron supplementation, suggesting that in such patients iron supplementation can obviate the need for invasive diagnostic procedures. In addition, these patients all had a platelet “overshoot” phenomenon during iron therapy prior to normalization of platelet counts, the mechanism of which is still unknown. The literature exploring the mechanism behind our clinical findings is reviewed.

Prenatal Iron Supplementation Reduces Maternal Anemia, Iron Deficiency, and Iron Deficiency Anemia in a Randomized Clinical Trial in Rural China, but Iron Deficiency Remains Widespread in Mothers and Neonates

“…An impact of prenatal iron supplements on platelets was not mentioned in the systematic reviews or metaanalyses of randomized clinical trials. However, reactive thrombocytosis has been reported with IDA; thrombocytopenia is also seen with severe IDA (25)(26)(27).…”

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

“…A rare cause includes a genetic mutation in TMPRSS6 leading to iron-refractory IDA [6]. Iron deficiency is often associated with thrombocytosis rather than thrombocytopenia; however, both have been described in the literature for more than 50 years [7]. On the other hand, iron replacement has a similar range of effects on thrombopoiesis [8].…”

Novel G6B gene variant causes familial autosomal recessive thrombocytopenia and anemia

“…Thrombocytopenia and anemia are two distinctive examples of these blood anomalies. Thrombocytopenia is characterized by low platelets counts that are below normal levels (˂50 000/μL) compared to healthy individuals, whereas anemia is caused by a reduction in hemoglobin contents and/or low red blood cell (RBC) counts . Platelets‐producing megakaryocytes (MEGs) and RBCs derive from a common ancestor progenitor cells in a process that is regulated by several transcription factors including GATA binding protein 1 (GATA1) .…”