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Thrombocytopenia in children with severe iron deficiency
Meryl K Perlman1, Joel G Schwab, James B Nachman
1Department of Pediatrics, The Pritzker School of Medicine, the University of Chicago, Illinois 60637, USA.
Insights
Severe iron deficiency in children can cause low platelet counts (thrombocytopenia). Treatment with iron supplements rapidly corrected this, suggesting iron is vital for platelet production.
Area of Science:
- Hematology
- Pediatric Medicine
- Nutritional Science
Background:
- Thrombocytopenia is sometimes observed in children with severe iron deficiency anemia.
- The link and underlying mechanisms between iron deficiency and thrombocytopenia require further clarification.
Purpose of the Study:
- To investigate the association between severe iron deficiency and thrombocytopenia in children.
- To describe cases and review literature on this hematologic condition.
Main Methods:
- Analysis of clinical, hematologic, and morphologic data from six children with severe iron deficiency and thrombocytopenia.
- Review of existing medical literature on the topic.
Main Results:
- Six children (14 months to 17 years) presented with severe microcytic anemia and thrombocytopenia.
- Iron deficiency stemmed from nutrition or menstrual blood loss; initial hemoglobin averaged 2.5 g/dL and platelet counts 64 x 10^9/L.
- Bone marrow exams revealed increased megakaryocytes; platelet counts normalized rapidly after oral iron therapy.
Conclusions:
- The study validates the association between severe iron deficiency and thrombocytopenia in pediatric patients.
- Elevated megakaryocytes and swift platelet count recovery post-iron therapy indicate iron's crucial role in late-stage thrombopoiesis.
Purpose:
Thrombocytopenia has been reported in some children with severe iron deficiency anemia, but the validity of the association and the mechanism of the thrombocytopenia are not well established. Six children with severe iron deficiency and thrombocytopenia are described, and the literature is reviewed.
Patients And Methods:
Clinical, hematologic, and morphologic data were collected and analyzed for six patients referred for evaluation of severe microcytic anemia and thrombocytopenia.
Results:
The children ranged in age from 14 months to 17 years (median age 27 months) and were otherwise healthy. The iron deficiency was nutritional in four patients younger than 3 years of age and resulted from menstrual blood loss in two teenage girls. The mean initial hemoglobin was 2.5 g/dL (range 1.6-4.7) and the mean initial platelet count was 64 x 109/L (range 11-102). Bone marrow examinations were performed in three patients and showed increased numbers of megakaryocytes. After treatment with therapeutic doses of oral iron, all the patients showed rapid increases in their platelet counts.
Conclusions:
These observations validate and extend previous reports of an association between severe iron deficiency and thrombocytopenia. The increased numbers of megakaryocytes and the extremely rapid increase in platelet counts after initiation of iron therapy suggest an essential role for iron in a late stage of thrombopoiesis.