Advertisement

Annals of Hematology

, Volume 98, Issue 10, pp 2299–2302 | Cite as

Iron deficiency, an unusual cause of thrombocytopenia: results from a multicenter retrospective case-controlled study

  • Tessa Huscenot
  • Luc Darnige
  • Orianne Wagner-Ballon
  • Anne-Marie Ronchetti
  • Valentine Lousteau
  • Nicolas Limal
  • Caroline Morbieu
  • Delphine Gobert
  • Julien Rohmer
  • Alexis Mathian
  • Marie Le Cann
  • Jehane Fadlallah
  • Laetitia Languille
  • Marc MichelEmail author
Original Article
  • 123 Downloads

Abstract

Iron deficiency anemia (IDA) is often associated with mild to moderate thrombocytosis, and iron deficiency–associated thrombocytopenia (IDAT) is much more uncommon and often misdiagnosed as immune thrombocytopenia (ITP). To better describe the features of IDAT, we conducted a retrospective multicenter case-control study. We identified 10 patients (9 women) with a definite diagnosis IDAT, with a median age of 43.5 [range, 16–72] years and a median platelet count of 30.5 × 109/L [range, 21–80], and 7 patients with a possible diagnosis of IDAT. Bleeding manifestations were absent in all patients but one. All the patients recovered (platelet count ≥ 150 × 109/L) upon iron therapy ± red blood cell transfusion after a median time of 6 [4–39] days. When compared with 30 randomly newly diagnosed ITP patients matched on age, the baseline platelet count was significantly lower in ITP (median = 7 × 109/L [4–59], p < 0.001) whereas MPV was higher (10.5 fL [9,4–13,8] vs 8.2 fL, for IDAT p < 0.001). The median platelet count on day 7 was 337 × 109/L [113–1000] for IDAT cases vs 72 × 109/L [13–212] for ITP controls (p < 0.001). IDAT is potentially an under-recognized cause of thrombocytopenia that may be easily managed with iron therapy.

Keywords

Thrombocytopenia Iron deficiency anemia Immune thrombocytopenia 

Notes

Compliance with ethical standards

The study was conducted in accordance with the ethical rules of the Helsinki Declaration and approved by our local IRB.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Verma V, Ayalew G, Sidhu G, Ramnaraign B, Cutler J, Khandekar S, Weedon J, Sharma G, Braverman AS (2015) An analysis of the relationship between severe iron deficiency anemia and thrombocytopenia. Ann Hematol 94(3):535–537CrossRefGoogle Scholar
  2. 2.
    Cunha V, Ferreira M, Barosa R, Fonseca AG, Delerue F, Carvalho C (2015) Iron-induced thrombocytopenia in severe iron-deficiency anemia. Expert Rev Hematol 8(2):247–251CrossRefGoogle Scholar
  3. 3.
    Beguin Y (1999) Erythropoietin and platelet production. Haematologica 84(6):541–547Google Scholar
  4. 4.
    Loo M, Beguin Y (1999) The effect of recombinant human erythropoietin on platelet counts is strongly modulated by the adequacy of Iron supply. Blood. 93(10):3286–3293Google Scholar
  5. 5.
    Xavier-Ferrucio J, Li X, Scanlon V, Zhang PZ, Ayala-Lopez N, Tebaldi T, Halene S, Finberg KE, Krause DS (2018) Low iron promotes megakaryocytic commitment of megakaryocytic-erythroid progenitors in human and mice. Blood 132:2.  https://doi.org/10.1182/blood-2018-99-115214 Google Scholar
  6. 6.
    Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kuhne T, Ruggeri M, George JN (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura (ITP) of adults and children: report from an international working group. Blood 113(11):2386–2393CrossRefGoogle Scholar
  7. 7.
    Tang Y, He P, Li Y, Chen H, Chang X, Xie Q et al (2017) Diagnostic value of platelet indices and bone marrow megakaryocytic parameters in immune thrombocytopenic purpura. Blood Coagul Fibrinolysis 28(1):83–90CrossRefGoogle Scholar
  8. 8.
    Khellaf M, Michel M, Quittet P, Viallard JF, Alexis M, Roudot-Thoraval F, Cheze S, Durand JM, Lefrere F, Galicier L, Lambotte O, Panelatti G, Slama B, Damaj G, Sebahoun G, Gyan E, Delbrel X, Dhedin N, Royer B, Schleinitz N, Rossi JF, Mahevas M, Languille L, Bierling P, Godeau B (2011) Romiplostim safety and efficacy for immune thrombocytopenia in clinical practice: 2-year results of 72 adults in a romiplostim compassionate-use program. Blood. 118(16):4338–4345CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tessa Huscenot
    • 1
  • Luc Darnige
    • 2
  • Orianne Wagner-Ballon
    • 3
  • Anne-Marie Ronchetti
    • 4
  • Valentine Lousteau
    • 5
  • Nicolas Limal
    • 1
  • Caroline Morbieu
    • 1
  • Delphine Gobert
    • 6
  • Julien Rohmer
    • 7
  • Alexis Mathian
    • 7
  • Marie Le Cann
    • 8
  • Jehane Fadlallah
    • 9
  • Laetitia Languille
    • 1
  • Marc Michel
    • 1
    Email author
  1. 1.Department of Internal Medicine, Hôpital Henri Mondor, National Referral Center for Adult’ Immune Cytopenias, Université Paris-Est CréteilAssistance Publique Hôpitaux de ParisCréteilFrance
  2. 2.Department of Hematobiology, Hôpital Européen Georges PompidouAssistance Publique Hôpitaux de ParisParisFrance
  3. 3.Department of Hôpital Henri Mondor, Université Paris-Est CréteilAssistance Publique HôpitauxCréteilFrance
  4. 4.Department of Clinical HematologyCentre Hospitalier Sud-FrancilienCorbeil-EssonnesFrance
  5. 5.Department of médecine interneCentre Hospitalier Alpes LemanContamine sur ArvesFrance
  6. 6.Department of Internal Medicine, Hôpital Saint-AntoineAssistance Publique Hôpitaux de ParisParisFrance
  7. 7.Department of Internal Medicine, Hôpital La Pitié SalpêtrièreAssistance Publique Hôpitaux de ParisParisFrance
  8. 8.Department of Hematobiology, Hôpital Saint-AntoineAssistance Publique Hôpitaux de ParisParisFrance
  9. 9.Department of Clinic Immunology, Hôpital Saint-LouisAssistance Publique Hôpitaux de ParisParisFrance

Personalised recommendations