DERGİSİ TIPDERGİSİ - DNT ORTADOĞU YAYINCILIK :: Anasayfa

junctivas were pale and her traube area was closed. Pathology
was not present in her biochemical parameters. In
her peripheral blood smear, erythrocytes were observed
as hipocromic-microcytic and 3-4 thrombocytes were observed
in each area, fragmentation was not seen in erythrocytes,
clumping thrombocyte was not present. It was
observed that the patient PT-aPTT, fibrinogen and lactate
dehydrogenase level were normal. The patient was given
4 units erythrocytes suspension. Tiroid hormones, hepatitis
markers, HIV, ANA, antids-DNA, brucellosis, immunoglobulin
G, A, M, b12 vitamin, folic acid and direct
antiglobulin tests done to diagnose the causes of thrombocytopenia
were normal. Bone marrow aspiration-biopsy
carried out to diagnose the thrombocytopenia, showed
slight increase in erythroid series and adequate numbers
of megakaryocytes. Hemoglobin was 7,49 gr/dl, platelet
was 29,5x103/uL after the 4 units erythrocyte suspension.
Since the serum ferritin level of the patient was 4,2ng/ml
(10-291), the patient was started with oral ferrous iron
treatment because the iron deficiency anemia. The patient’s
blood counts, whose thrombocyte levels turned out
to be normal after 7 days of the iron treatment, showed that
her hb was 11 gr/dl, WBC was 6,95x103/uL and platelet
was 385x103/uL.
Iron deficiency is one of the uncommon causes of thrombocytopenia.
The presence of both anemia and thrombocytopenia
may cause the consideration of serious-malignant
bone marrow dysfunction (2). Also in our case, serious
profound anemia and thrombocytopenia were present and
bone marrow aspiration-biopsy was applied in terms of
malignant bone marrow pathology. However, pathological
cell increase was not observed in bone marrow biopsy. If
a secondary cause is not found out and if megakaryocyte
increase in bone marrow is observed, this suggests ITP and
it may require the use of steroids during the treatment. Iron
deficiency induced thrombocytopenia may also cause megakaryocyte
increase in bone marrow and this may cause
false diagnosis of ITP (3). There was not another secondary
reason to cause thrombocytopenia in our patient. Her
bone marrow examination showed that megakaryocytes
counts were normal considering the presence of ITP.
Iron deficiency anemia induced thrombocytopenia, turned
out to be normal within 48 hours or 3 weeks after the oral
or intravenous iron treatment (2,3,6). Also in our case, it
has been found out that thrombocyte counts turned out to
be normal 1 week after the oral ferrous iron treatment.
As conclusion, although iron deficiency anemia often
cause thrombocytosis, it may rarely cause thrombocytopenia.
Other secondary reasons which may cause thrombocytopenia
should be eliminated before the patient is diag-
Iron Deficiency İnduced Thrombocytopenia
nosed with iron deficiency induced thrombocytopenia and
when the patient was started with iron treatment, the patient
should be provided with close observations in terms
of thrombocyte counts after the treatment.
References
1.Kuku I, Kaya E, Yoloğlu S, Gökdeniz R, Baydın A. Platelet counts in
adults with iron deficiency anemia. Platelets. 2009;20(6):401-405
2.Morris VK, Spraker HL, Howard SC, Ware RE, Reiss UM. Severe
thrombocytopenia with iron deficiency anemia. Pediatr Hematol Oncol.
2010;27(5):413-419
3.Chaker S, Very S, Helley D, Gaussem P, Pouchot J, Dranige L, Fischer
AM, Capron L, Arlet JB. Thrombocytopenia associated with iron deficiency:
a rare differential diagnosis of auto-immune thrombocytopenic
purpura. Rev Med Interne. 2010;31(9):631-636
4.Sonneborn D. Letter: Thrombocytopenia and iron deficiency. Ann Intern
Med. 1974;80 (1):111
5.Berger M, Bras LF. Severe thrombocytopenia in iron deficiency anemia.
Am J Hematol. 1987;24(4):425-428
6.Shah BK, Shah T. Iron deficiency thrombocytopenia: a case report.
Med Princ Pract. 2011;20(5):483-484
Correspondink Author: Hava ÜSKÜDAR TEKE MD
Kayseri Education And Research Hospital, Hematology
Department, Kayseri-TURKEY
E-mail:havaus@yahoo.com
ORTADOĞU TIP DERGİSİ 4 (2): 102-103 2012
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