Li Xue, Li Nanyi, Zhao Guangjie, Wang Xiaoqin
Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China.
Health Management Center, Huashan Hospital, Fudan University, Shanghai, China.
Platelets. 2022 Nov 17;33(8):1214-1219. doi: 10.1080/09537104.2022.2091772. Epub 2022 Sep 1.
Iron deficiency anemia (IDA) affects more than 1.2 billion individuals globally. In addition to anemia, reactive thrombocytosis is also a common clinical hematological condition in patients with IDA. However, some case reports have described the thrombotic complications in association with IDA-induced thrombocytosis. Patients with a high risk of thrombosis need prompt identification and effective treatment to prevent thrombotic complications. While iron replacement treatment has been shown to decrease platelet count in this context, there is limited published evidence on how iron supplementation affects the thrombocytosis caused by IDA. We retrospectively examined the clinical records of 440 patients with IDA from an RCT completed from 1 January 2016, to 30 December 2017, and data obtained from this study was used for post hoc analysis to examine the effect of iron on platelet count in IDA-induced thrombocytosis.The mean ± standard deviation (SD) platelet counts of the 440 patients with IDA was 310.23 ± 98.72 × 10/L. With baseline platelet counts>450 × 10 /L as the cutoff for thrombocytosis, patients were divided into 2 groups: 36 (8.1%) in the IDA with thrombocytosis group (mean ± SD platelet count, 521.67 ± 73.85 × 10/L) and the remaining 404 in the IDA without thrombocytosis group (mean ± SD platelet count, 291.39 ± 76.11 × 10/L).Differences were found in baseline characteristics including white blood cell (WBC) count, hemoglobin (Hb) level, mean corpuscular volume (MCV), transferrin saturation (TSAT), serum iron (SI) level, and total iron-binding capacity (TIBC) between the two groups ( < .05). From baseline to 8 weeks of continuous iron supplementation treatment, the mean platelet counts in both groups were decreased at 2-week treatment intervals. And in the IDA with thrombocytosis group, half of the patients resolved thrombocytosis after 2 weeks of iron supplementation, and the counts of all patients with thrombocytosis decreased below 450 × 10 /L within 6 weeks.In conclusion, the rate of reactive thrombocytosis in patients with IDA was 8.1%. IDA patients with thrombocytosis showed more severe anemia, lower ferritin, and more advanced iron deficiency than those without thrombocytosis. Platelet counts of half of the patients with thrombocytosis reduced below cut off of 450 × 10/L for thrombocytosis after 2 weeks of treatment, and all patients resolved thrombocytosis after 6 weeks. Our study provided clinical evidence for more effective and individualized iron management in the future. IDA patients with thrombocytosis should take active iron treatment and increase follow-up frequency to prevent thrombotic events. For patients with persistent thrombocytosis, a concomitant clonal process should be considered.
缺铁性贫血（IDA）在全球影响着超过12亿人。除贫血外，反应性血小板增多也是IDA患者常见的临床血液学状况。然而，一些病例报告描述了与IDA诱导的血小板增多相关的血栓形成并发症。血栓形成风险高的患者需要及时识别并进行有效治疗以预防血栓形成并发症。虽然在这种情况下铁替代治疗已被证明可降低血小板计数，但关于铁补充剂如何影响IDA引起的血小板增多的已发表证据有限。我们回顾性检查了2016年1月1日至2017年12月31日完成的一项随机对照试验中440例IDA患者的临床记录，并将本研究获得的数据用于事后分析，以研究铁对IDA诱导的血小板增多中血小板计数的影响。
440例IDA患者的平均血小板计数±标准差（SD）为310.23±98.72×10⁹/L。以基线血小板计数>450×10⁹/L作为血小板增多的临界值，患者分为两组：血小板增多的IDA组36例（8.1%）（平均血小板计数±SD，521.67±73.85×10⁹/L），其余404例为无血小板增多的IDA组（平均血小板计数±SD，291.39±76.11×10⁹/L）。两组在基线特征包括白细胞（WBC）计数、血红蛋白（Hb）水平、平均红细胞体积（MCV）、转铁蛋白饱和度（TSAT）、血清铁（SI）水平和总铁结合力（TIBC）方面存在差异（P<0.05）。从基线到连续铁补充治疗8周，两组的平均血小板计数在2周治疗间隔时均下降。并且在血小板增多的IDA组中，一半的患者在铁补充2周后血小板增多得到缓解，所有血小板增多患者的计数在6周内降至450×10⁹/L以下。
总之，IDA患者中反应性血小板增多的发生率为8.1%。有血小板增多的IDA患者比无血小板增多的患者表现出更严重的贫血、更低的铁蛋白和更严重的缺铁。血小板增多患者中有一半在治疗2周后血小板计数降至血小板增多临界值450×10⁹/L以下，所有患者在6周后血小板增多得到缓解。我们的研究为未来更有效和个体化的铁管理提供了临床证据。有血小板增多的IDA患者应积极进行铁治疗并增加随访频率以预防血栓形成事件。对于持续性血小板增多的患者，应考虑合并克隆性过程。
