THROMBOCYTOPENIA AFTER IRON INFUSION: A CASE SERIES OF FOUR PATIENTS AND REVIEW OF LITERATURE
(Abstract release date: 05/19/16)
EHA Library. Lioger B. 06/09/16; 135042; PB2142
Dr. Bertrand Lioger
Contributions
Contributions
Abstract
Abstract: PB2142
Type: Publication Only
Background
Among all the etiologies of anemia worldwide, iron deficiency remains the leading cause and might be present in 1 to 2% of adults. A thrombocytosis between 500 to 700 x 109/L or more rarely a thrombocytopenia under 100 x 109/L have also been described. The management of iron deficiency involves the research and treatment of a bleeding; an iron uptake quantification with a dietary survey followed by an oral or intravenous iron supplementation. However, published cases of secondary thrombocytopenia after an iron injection remain troublesome and underline our partial understanding of its mechanism of action.
Aims
The objective of our study was to describe the clinical and biological characteristics of thrombocytopenia occurring after iron infusion in patients.
Methods
Two strategies have been applied to collect cases. On one side, we have searched through the French Pharmacovigilance Database (FPVD); and on the other side, we have performed a systematic review. We used 'thrombocytopenia' as high level term (MedDRA 11.0) and drug exposition was defined by the presence in the report of intravenous iron coded “suspect” according to the WHO criteria, whatever the level of causality assessment.
Results
This study found 9 patients (1M, 8F) having thrombocytopenia after intravenous iron products, four from the FPVD and five from the literature. The median age at diagnosis was 37 years old (range 16-90). The spectrum of iron supplementation included bleeding (n=6), malabsorption (n=1), a peritoneal dialysis (n=1), and an inflammatory anemia (n=1). The hemoglobin level was 5.7 ± 2.3 g/L (range 3.1-9.6) with a median MCV 63 fL and a median platelet counts of 172 ± 133 x 109/L (range 102-434). Two patients had thrombocytosis before admission. Before intravenous iron products, four patients have received oral iron drugs and units of packed red blood cells for two patients. Treatment of intravenous iron consisted of iron sucrose (n=8) and ferric carboxymaltose (n=1). One patient was treated with intramuscular injection of iron sucrose.The median time to the onset of the thrombocytopenia was 3 ± 2.4 days (range 2-8). The average decrease in platelets count compared to the baseline was 85%. The available bone marrow aspirations showed a megakaryocytic hypoplasia (n=4) or no abnormality of the megakaryocytes (n=2). Two patients have experienced hemorrhagic events. One has epistaxis and the other one purpuric ecchymosis. Only one patient received packed of platelets.We aimed to identify some subsets of patients according to their baseline characteristics. However, there was no difference between patients with early (< 3 days) or late (> 3 days) thrombocytopenia.
Conclusion
As we reported only nine cases in this study, we hypothesize that thrombocytopenia secondary to an iron infusion remains an uncommon adverse drug reaction. Our statement is also supported by the absence of similar data from the European Medicines Agency and the Food and Drug Administration. The appearance of thrombocytopenia does not seem specific of the intravenous form because some cases of thrombocytopenia have been reported with oral iron products. Withdraw of IV iron remained the first option of treatment and platelet transfusions was added if necessary. The main entity in the differential diagnosis of iron-induced thrombocytopenia is thrombocytopenia associated with IDA. In conclusion, clinicians should be aware of this possibility, as in one hand iron is the treatment of thrombocytopenia and on the other hand, iron might be the trigger of the thrombocytopenia.
Session topic: E-poster
Keyword(s): Adverse reaction, Iron deficiency anemia, Thrombocytopenia
Type: Publication Only
Background
Among all the etiologies of anemia worldwide, iron deficiency remains the leading cause and might be present in 1 to 2% of adults. A thrombocytosis between 500 to 700 x 109/L or more rarely a thrombocytopenia under 100 x 109/L have also been described. The management of iron deficiency involves the research and treatment of a bleeding; an iron uptake quantification with a dietary survey followed by an oral or intravenous iron supplementation. However, published cases of secondary thrombocytopenia after an iron injection remain troublesome and underline our partial understanding of its mechanism of action.
Aims
The objective of our study was to describe the clinical and biological characteristics of thrombocytopenia occurring after iron infusion in patients.
Methods
Two strategies have been applied to collect cases. On one side, we have searched through the French Pharmacovigilance Database (FPVD); and on the other side, we have performed a systematic review. We used 'thrombocytopenia' as high level term (MedDRA 11.0) and drug exposition was defined by the presence in the report of intravenous iron coded “suspect” according to the WHO criteria, whatever the level of causality assessment.
Results
This study found 9 patients (1M, 8F) having thrombocytopenia after intravenous iron products, four from the FPVD and five from the literature. The median age at diagnosis was 37 years old (range 16-90). The spectrum of iron supplementation included bleeding (n=6), malabsorption (n=1), a peritoneal dialysis (n=1), and an inflammatory anemia (n=1). The hemoglobin level was 5.7 ± 2.3 g/L (range 3.1-9.6) with a median MCV 63 fL and a median platelet counts of 172 ± 133 x 109/L (range 102-434). Two patients had thrombocytosis before admission. Before intravenous iron products, four patients have received oral iron drugs and units of packed red blood cells for two patients. Treatment of intravenous iron consisted of iron sucrose (n=8) and ferric carboxymaltose (n=1). One patient was treated with intramuscular injection of iron sucrose.The median time to the onset of the thrombocytopenia was 3 ± 2.4 days (range 2-8). The average decrease in platelets count compared to the baseline was 85%. The available bone marrow aspirations showed a megakaryocytic hypoplasia (n=4) or no abnormality of the megakaryocytes (n=2). Two patients have experienced hemorrhagic events. One has epistaxis and the other one purpuric ecchymosis. Only one patient received packed of platelets.We aimed to identify some subsets of patients according to their baseline characteristics. However, there was no difference between patients with early (< 3 days) or late (> 3 days) thrombocytopenia.
Conclusion
As we reported only nine cases in this study, we hypothesize that thrombocytopenia secondary to an iron infusion remains an uncommon adverse drug reaction. Our statement is also supported by the absence of similar data from the European Medicines Agency and the Food and Drug Administration. The appearance of thrombocytopenia does not seem specific of the intravenous form because some cases of thrombocytopenia have been reported with oral iron products. Withdraw of IV iron remained the first option of treatment and platelet transfusions was added if necessary. The main entity in the differential diagnosis of iron-induced thrombocytopenia is thrombocytopenia associated with IDA. In conclusion, clinicians should be aware of this possibility, as in one hand iron is the treatment of thrombocytopenia and on the other hand, iron might be the trigger of the thrombocytopenia.
Session topic: E-poster
Keyword(s): Adverse reaction, Iron deficiency anemia, Thrombocytopenia
Abstract: PB2142
Type: Publication Only
Background
Among all the etiologies of anemia worldwide, iron deficiency remains the leading cause and might be present in 1 to 2% of adults. A thrombocytosis between 500 to 700 x 109/L or more rarely a thrombocytopenia under 100 x 109/L have also been described. The management of iron deficiency involves the research and treatment of a bleeding; an iron uptake quantification with a dietary survey followed by an oral or intravenous iron supplementation. However, published cases of secondary thrombocytopenia after an iron injection remain troublesome and underline our partial understanding of its mechanism of action.
Aims
The objective of our study was to describe the clinical and biological characteristics of thrombocytopenia occurring after iron infusion in patients.
Methods
Two strategies have been applied to collect cases. On one side, we have searched through the French Pharmacovigilance Database (FPVD); and on the other side, we have performed a systematic review. We used 'thrombocytopenia' as high level term (MedDRA 11.0) and drug exposition was defined by the presence in the report of intravenous iron coded “suspect” according to the WHO criteria, whatever the level of causality assessment.
Results
This study found 9 patients (1M, 8F) having thrombocytopenia after intravenous iron products, four from the FPVD and five from the literature. The median age at diagnosis was 37 years old (range 16-90). The spectrum of iron supplementation included bleeding (n=6), malabsorption (n=1), a peritoneal dialysis (n=1), and an inflammatory anemia (n=1). The hemoglobin level was 5.7 ± 2.3 g/L (range 3.1-9.6) with a median MCV 63 fL and a median platelet counts of 172 ± 133 x 109/L (range 102-434). Two patients had thrombocytosis before admission. Before intravenous iron products, four patients have received oral iron drugs and units of packed red blood cells for two patients. Treatment of intravenous iron consisted of iron sucrose (n=8) and ferric carboxymaltose (n=1). One patient was treated with intramuscular injection of iron sucrose.The median time to the onset of the thrombocytopenia was 3 ± 2.4 days (range 2-8). The average decrease in platelets count compared to the baseline was 85%. The available bone marrow aspirations showed a megakaryocytic hypoplasia (n=4) or no abnormality of the megakaryocytes (n=2). Two patients have experienced hemorrhagic events. One has epistaxis and the other one purpuric ecchymosis. Only one patient received packed of platelets.We aimed to identify some subsets of patients according to their baseline characteristics. However, there was no difference between patients with early (< 3 days) or late (> 3 days) thrombocytopenia.
Conclusion
As we reported only nine cases in this study, we hypothesize that thrombocytopenia secondary to an iron infusion remains an uncommon adverse drug reaction. Our statement is also supported by the absence of similar data from the European Medicines Agency and the Food and Drug Administration. The appearance of thrombocytopenia does not seem specific of the intravenous form because some cases of thrombocytopenia have been reported with oral iron products. Withdraw of IV iron remained the first option of treatment and platelet transfusions was added if necessary. The main entity in the differential diagnosis of iron-induced thrombocytopenia is thrombocytopenia associated with IDA. In conclusion, clinicians should be aware of this possibility, as in one hand iron is the treatment of thrombocytopenia and on the other hand, iron might be the trigger of the thrombocytopenia.
Session topic: E-poster
Keyword(s): Adverse reaction, Iron deficiency anemia, Thrombocytopenia
Type: Publication Only
Background
Among all the etiologies of anemia worldwide, iron deficiency remains the leading cause and might be present in 1 to 2% of adults. A thrombocytosis between 500 to 700 x 109/L or more rarely a thrombocytopenia under 100 x 109/L have also been described. The management of iron deficiency involves the research and treatment of a bleeding; an iron uptake quantification with a dietary survey followed by an oral or intravenous iron supplementation. However, published cases of secondary thrombocytopenia after an iron injection remain troublesome and underline our partial understanding of its mechanism of action.
Aims
The objective of our study was to describe the clinical and biological characteristics of thrombocytopenia occurring after iron infusion in patients.
Methods
Two strategies have been applied to collect cases. On one side, we have searched through the French Pharmacovigilance Database (FPVD); and on the other side, we have performed a systematic review. We used 'thrombocytopenia' as high level term (MedDRA 11.0) and drug exposition was defined by the presence in the report of intravenous iron coded “suspect” according to the WHO criteria, whatever the level of causality assessment.
Results
This study found 9 patients (1M, 8F) having thrombocytopenia after intravenous iron products, four from the FPVD and five from the literature. The median age at diagnosis was 37 years old (range 16-90). The spectrum of iron supplementation included bleeding (n=6), malabsorption (n=1), a peritoneal dialysis (n=1), and an inflammatory anemia (n=1). The hemoglobin level was 5.7 ± 2.3 g/L (range 3.1-9.6) with a median MCV 63 fL and a median platelet counts of 172 ± 133 x 109/L (range 102-434). Two patients had thrombocytosis before admission. Before intravenous iron products, four patients have received oral iron drugs and units of packed red blood cells for two patients. Treatment of intravenous iron consisted of iron sucrose (n=8) and ferric carboxymaltose (n=1). One patient was treated with intramuscular injection of iron sucrose.The median time to the onset of the thrombocytopenia was 3 ± 2.4 days (range 2-8). The average decrease in platelets count compared to the baseline was 85%. The available bone marrow aspirations showed a megakaryocytic hypoplasia (n=4) or no abnormality of the megakaryocytes (n=2). Two patients have experienced hemorrhagic events. One has epistaxis and the other one purpuric ecchymosis. Only one patient received packed of platelets.We aimed to identify some subsets of patients according to their baseline characteristics. However, there was no difference between patients with early (< 3 days) or late (> 3 days) thrombocytopenia.
Conclusion
As we reported only nine cases in this study, we hypothesize that thrombocytopenia secondary to an iron infusion remains an uncommon adverse drug reaction. Our statement is also supported by the absence of similar data from the European Medicines Agency and the Food and Drug Administration. The appearance of thrombocytopenia does not seem specific of the intravenous form because some cases of thrombocytopenia have been reported with oral iron products. Withdraw of IV iron remained the first option of treatment and platelet transfusions was added if necessary. The main entity in the differential diagnosis of iron-induced thrombocytopenia is thrombocytopenia associated with IDA. In conclusion, clinicians should be aware of this possibility, as in one hand iron is the treatment of thrombocytopenia and on the other hand, iron might be the trigger of the thrombocytopenia.
Session topic: E-poster
Keyword(s): Adverse reaction, Iron deficiency anemia, Thrombocytopenia
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