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Thrombocytopenia in severe iron deficiency anemia in children
Machiel van den Akker1,2,3, Laura Chielens4, Lisa Lopes5
1Department of Pediatrics ZNA Queen Paola Children's Hospital Antwerp Belgium.
Insights
Children with severe iron deficiency anemia (IDA) and thrombocytopenia often improve with iron treatment. Empiric iron therapy is recommended for stable children with IDA and thrombocytopenia when other causes are unlikely.
Area of Science:
- Pediatric Hematology
- Nutritional Deficiencies
Background:
- Iron deficiency anemia (IDA) is prevalent in children, typically causing thrombocytosis, but rarely thrombocytopenia.
- Profound thrombocytopenia in pediatric IDA is an uncommon presentation.
Purpose of the Study:
- To describe cases of pediatric IDA with thrombocytopenia.
- To compare findings with existing literature.
- To evaluate the efficacy of iron treatment.
Main Methods:
- Retrospective case series of patients under 19 years old.
- Data collected from two tertiary medical centers over 10 years.
- Comparison with published medical literature.
Main Results:
- All patients with severe IDA and thrombocytopenia showed improvement with iron treatment.
- Thrombocytopenia was often severe (platelet count <50×10E9/L), though major bleeding was absent.
- Platelet counts peaked within one month of iron treatment initiation; some cases developed thrombocytopenia after iron supplementation.
Conclusions:
- Empiric iron monotherapy is warranted for clinically stable children with severe IDA and thrombocytopenia.
- This approach can prevent unnecessary investigations and treatments.
- Further research into the mechanisms of IDA-associated thrombocytopenia may be beneficial.
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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