Discussion:
An underrated thromboembolic risk factor is IDA. Moreover, secondary thrombocytosis associated with IDA is typically regarded as benign. However, mounting data suggests that raised platelet counts, particularly in an iron shortage, can increase the risk of thromboembolism in both venous and arterial systems.3Moreover, numerous VTE occurrences linked to IDA have been documented in several investigations. An incidence of severe IDA with substantial thrombocytosis was reported in one inquiry and was exacerbated by central retinal vein occlusion.4 Following the administration of ferrous fumarate, the platelet count was found to have immediately fallen, combined with an improvement in central venous occlusion. This is the only therapy technique that supports the theory that IDA caused the VTE incidence.4 This process might explain the connection between IDA, reversible localized impairments and strokes identified by specific authors.5
The causes of thrombocytosis in IDA and the subsequent VTE are not fully understood. Several theories have attempted to explain this link. First, thrombopoiesis is significantly regulated by iron.6Therefore, adequate iron levels are essential to avoid thrombocytosis by suppressing thrombopoiesis. As a result, IDA is linked to a lack of thrombocytosis inhibition, which increases the risk of thrombosis.7
Additionally, distinct pathogenic pathways have been hypothesized since not all occurrences of iron-related thrombotic events occur in individuals with simultaneously high platelet counts. One such hypothesized mechanism, for instance, concentrates on the antioxidant effect of iron. Consequently, in addition to the increased thrombotic risk of thrombocytosis, some writers have argued that IDA’s impaired antioxidant protection may also increase oxidative stress, which might subsequently contribute to a predisposition for platelet aggregation.8 An alternative explanation is the disrupted blood circulation pattern found in iron deficiency. Due to the decreased deformability and high viscosity of microcytic red blood cells produced by iron deficiency, blood flow patterns within the arteries may be disrupted, leading to a hypercoagulable condition.9
Patients who experience recurrent VTEs undergo a thorough workup that excludes essential, undetectable risk factors like IDA. This is especially true when thrombocytosis is present. Therefore, we recommend that individuals with unexplained, unprovoked VTEs undergo routine screening for IDA.