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.