DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192748

Clinico-hematological study of abnormalities of platelet count in children with iron deficiency anemia

Sanghamitra Ray, Jagdish Chandra, Sunita Sharma

Abstract


Background: Iron deficiency anemia is a major cause of morbidity in developing countries like India. The aim of the study was to assess abnormalities of platelet count in iron deficiency anemia and to relate the severity of thrombocytosis with severity of anemia and its association with erythropoietin (EPO) level.

Methods: A prospective observational study comprising of 200 children below 18 years confirmed to have IDA. Erythropoietin (EPO) level was done in patients who had thrombocytosis. Degree of thrombocytosis was correlated with EPO and also with ferritin, haematological indices like hemoglobin and MCV (mean corpuscular volume) and blood counts were followed up while on iron therapy for one month.

Results: Thrombocytosis was noted in 24.5%. In 75.5% thrombocytosis was mild. Platelet had negative correlation with Hb (hemoglobin). EPO was elevated in 67.35% of thrombocytosis. EPO showed negative correlation with Hb and Ferritin and positive correlation with platelet however, these were non-significant. All patients were treated with standard preparation of ferrous fumarate (33mg elemental iron every 5 ml) in a dose of 3mg/kg/day of elemental iron along with appropriate dietary advice.  On one month follow up 92% of the study population showed normalization of platelet count.

Conclusions: Nearly One-fourth of children had thrombocytosis. Platelet count was inversely related to Hb and ferritin level. EPO was increased in two-third cases of thrombocytosis and showed positive correlation with platelet count. As authors excluded patients with severe IDA requiring blood transfusion, authors did not get any thrombocytopenia in present study.


Keywords


Children, Erythropoietin, Iron deficiency anemia, Thrombocytosis

Full Text:

PDF

References


International institute for population. Sciences (IIPS) and Macro International. 2007. National Family. Health Survey (NFHS-3), 2005–06. Available at: www. http://rchiips.org/nfhs/nfhs3.shtml. Accessed 10 December 2010.

Walter T. Effect of iron-deficiency anaemia on cognitive skills in infancy and childhood. Baill Clin Haem. 1994;7:815-27.

Belman AL, Roque CT, Ancona R, Anand AK, Davis RP. Cerebral venous thrombosis in a child with iron deficiency anaemia and thrombocytosis. Stroke. 1990;21(3):488-93.

Akins PT, Glenn S, Nemeth PM, Derdeyn CP. Carotid artery thrombus associated with severe iron-deficiency anaemia and thrombocytosis. Stroke. 1996;27(5):1002-5.

Maguire JL, deveber G, Parkin PC. Association between iron-deficiency anaemia and stroke in young children. Pediatr. 2007;120(5):1053-7.

Yadav D, Chandra J, Sharma S, Singh V. Clinicohematological study of thrombocytosis. Indian J Pediatr. 2010;77(6):643-7.

Bilic E, Bilic E. Amino acid sequence homology of thrombopoietin and erythropoietin may explain thrombocytosis in children with iron deficiency anemia. J Pediatr Hematol/Oncol. 2003;25(8):675.

Racke FK. EPO and TPO sequences do not explain thrombocytosis in iron deficiency anaemia. J Pediatr Hematol/Oncol. 2003;25(11):919.

Duzgun S, Yildirmak Y, Çetinkaya F. Neutrophil hypersegmentation and thrombocytosis in children with iron deficiency anemia. Turkish J Pediatr. 2005;47(3):251.

Robert IH, Samuel EL, Tomas PS. Blood. Principles Pract Hematol. 2003:1;1980.

Boenisch T. Improved enzymeimmunoassay for trace proteins. Prot. Biol. Fluids Proc Colloq. 1976; 24:743-9.

Huberman AM, Perez C. Nonheme iron determination. Anal Biochem. 2002;307(2):375-8.

Yamanishi H, Iyama S, Yamaguchi Y, Kanakura Y, Iwatani Y. Total iron-binding capacity calculated from serum transferrin concentration or serum iron concentration and unsaturated iron-binding capacity. Clin Chem. 2003;49:175-8.

Garcia JF, Ebbe SN, Hollander L, Cutting HO, Miller ME, Cronkite EP. Radioimmunoassay of erythropoietin: circulating levels in normal and polycythemic human beings. J Lab Clinic Med. 1982;99(5):624-35.

Karimi M, Mirzeai M, Dehghani A. Prevalence of anemia, iron deficiency and iron deficiency anemia in 6-60-month-old children in Yazd’s rural area. Int J Pediatr. 2004;9(3):180-4.

Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Brit J Hematol. 2005;129:165-77.

Voigt W, Jordan K, Sippel C, Amoury M, Schmoll HJ, Wolf HH. Severe thrombocytosis and anemia associated with celiac disease in a young female patient: a case report. J Med Case Rep. 2008;2(1):96.

Donald C, Van D, Miguel L, Garcia JF, Pollycov EM. Relation between severity of anemia and erythropoietin titre in human beings. Blood. 1961;18(2):187-201.

Yohannan MD, Higgy KE, Al-Mashhadani SA, Santhosh-Kumar CR. Thrombocytosis: etiologic analysis of 663 patients. Clinic Pediatr. 1994;33(6):340-3.

Kasper CK, Whissell DY, Wallerstein RO. Clinical aspects of iron deficiency. JAMA. 1965;191(5):359-63.

Nagai T, Komatsu N, Sakata Y, Miura Y, Ozaw A K. Iron deficiency anaemia with marked thrombocytosis complicated by central retinal vein occlusion. Int Med. 2005;44(10):1090-2.

Akan H, Güven N, Ayogdu İ, Arat M, Beksaç M, Dalva K. Thrombopoietic cytokines in patients with iron deficiency anemia with or without thrombocytosis. Acta Haematol. 2000;103(3):152-6.

Wolf RF, Gilmore LS, Friese P, Downs T, Burstein SA, Dale GL. Erythropoietin potentiates thrombus development in a canine arterio-venous shunt model. Thrombos Haemost. 1997;77(05):1020-4.

Akan H, Güven N, Ayogdu İ, Arat M, Beksaç M, Dalva K. Thrombopoietic cytokines in patients with iron deficiency anemia with or without thrombocytosis. Acta Haematol. 2000;103(3):152-6.

Schreiber S, Howaldt S, Schnoor M, Nikolaus S, Bauditz J, Gasché C, et al. Recombinant erythropoietin for the treatment of anemia in inflammatory bowel disease. New Eng J Med. 1996;334(10):619-24.

Wiedmeier SE, Henry E, Burnett J, Anderson T, Christensen RD. Thrombocytosis in neonates and young infants: a report of 25 patients with platelet counts of ≥1,000,000 μl-1extreme thrombocytosis. J Perinatol. 2010;30:222-6.