Curious Clinicians #129 - Ironing Out More Platelets

Why does iron deficiency cause thrombocytosis?

The differential for thrombocytopenia, or low platelets, is a classic. Are all the cell lines down? Usually bone marrow suppression due to anything from leukemia to Lyme disease. Is there new, severe thrombocytopenia and anemia? Make sure to rule out a microangiopathic hemolytic anemia (MAHA). Is there portal hypertension with splenomegaly? It’s probably sequestration. When platelets are low, there’s usually a reason we can find. How about when platelets are high? To be honest, most of us see thrombocytosis on a complete blood count and mutter something about it being “reactive” while hoping the number is normal on the next. Which, to be fair, is a reasonable answer, as platelets are an acute-phase reactant. But next time you see a platelet count of 600,000 on a CBC, add this to your differential: Iron deficiency.

1. Review the frequency and mechanism of thrombocytosis in iron deficiency.
2. Apply the concept of ploidy to megakaryocytes.
3. Generate potential reasons why the body might decrease RBC production in iron deficiency.

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The planning committee members report having no relevant financial relationships to disclose:

Hannah Abrams 
Tony Breu
Avi Cooper

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Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Hannah R Abrams, MD
Fellow
Fred Hutchinson Cancer Center

Faculty

Nothing to disclose

Anthony Breu, MD
Assistant Professor of Medicine
Adjunct Assistant Professor of Medicine
Harvard Medical School | Boston University School of Medicine

Faculty

Nothing to disclose

Avraham Cooper, MD
Assistant Program Director, Pulmonary Critical Care Medicine
Ohio State University Wexner Medical Center

Faculty

Nothing to disclose