Iron deficiency anemia and reactive thrombocytosis in a woman with heavy menstrual bleeding: A case report

Abstract

Thrombocytosis is frequently encountered in clinical practice and requires a rigorous diagnostic approach to accurately determine its underlying cause. It could be primary, such as essential thrombocythemia (ET), or secondary to chronic inflammation, hemorrhage, or iron deficiency anemia (IDA). Herein, a 32-year-old woman had iron deficiency-induced thrombocytosis; she was treated with intravenous iron supplements for one month, but thrombocytosis persisted. Therefore, the subsequent differential diagnosis was a JAK2-negative ET, and she was managed with cytoreduction and an antiplatelet agent. Despite this, her erythrocyte counts and thrombocytes increased, accompanied by microcytic hypochromic anemia. Laboratory tests and detailed clinical reassessment ultimately identified IDA secondary to heavy menstrual bleeding.  Subsequently, she missed her cycle for three months, with continuing iron supplements, which together led to the correction of anemia and subsequently resolution of the reactive thrombocytosis. This case report reminds clinicians to provide sufficient time following treatment before reassessing cases with thrombocytosis secondary to IDA, and the definitive diagnosis of clonal neoplasms, such as ET, requires fulfilment of the well-established diagnostic criteria.