LETTER TO THE EDITOR An analysis of the relationship between severe iron deficiency anemia and thrombocytopenia Vaibhav Verma & Getinet Ayalew & Gurinder Sidhu & Brian Ramnaraign & Jed Cutler & Sadia Khandekar & Jeremy Weedon & Geeti Sharma & Albert S Braverman Received: 28 July 2014 /Accepted: 26 August 2014 # Springer-Verlag Berlin Heidelberg 2014 Dear Editor Introduction In patients with iron deficiency anemia (IDA), platelet counts are almost invariably normal or increased. Associated throm- bocytopenia (TCP) is rare, especially in adults [1–8]. Here, we report 10 women with IDA, mostly due to menorrhagia, and thrombocytopenia, which responded rapidly, completely, and durably to effective treatment of the anemia and/or iron deficiency. We compared the hematologic parameters of these 10 patients to those of 25 women who had been diagnosed with IDA. Significant differences were found which may be related to the pathogenesis of the TCP. Patients and methods All IDA patients who presented to the Hematology Services at Kings County and Downstate Medical Center with unexplained TCP, between 2009 and 2012, were included in the study. Standard hematologic parameters were the criteria for IDA, and most had specific serum iron and ferritin studies. The same criteria were applied to the 49 patients who had been diagnosed with IDA on the Gynecology Service in the same period; 13 had serum iron and ferritin studies. Eligibility criteria were Hb<100 g/L, MCV<82 fL, and red cell- distribution width (RDW)>15 %. All of the TCP, but only 25 of the 49 control IDA patients, fulfilled these criteria. Two- tailed Mann-Whitney tests were used to compare the distribu- tion of age and of blood parameters between thrombocytope- nic and normal subjects. There were no animal or human rights violation. The study was deemed to be IRB exempt by the IRB committee of the hospital and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Results The normal platelet count range in our laboratories was 130×10 9 /L to 350×10 9 /L. All 10 thrombocytopenic pa- tients were African American women with symptomatic IDA. Menorrhagia due to uterine fibroids was the cause of IDA in nine of them, and colonic diverticulosis in one. There were no other bleeding sites. None had palpable splenomegaly or were on medications known to cause thrombocytopenia. White blood cell and differential counts were normal. Bone marrow aspirations and biopsies from two patients revealed an increased percentage of erythroid precursors, with some increase in megakaryocytes. Serum B12, folate, and lactic dehydrogenase levels were normal and Coombs tests were negative. Reticulocyte percentages ranged from 0.74 to 3.6, median 1.7. The ages and hematologic parameters of the control and TCP patients are presented in Table 1; the latter were significantly AB was the principal investigator. VV, GA, GS, BR, JC, SK, and GS participated in co-ordinating the research and literature review and writ- ing the paper. JW participated in the statistical analysis. V. Verma (*) : G. Ayalew : G. Sidhu : B. Ramnaraign : J. Cutler : S. Khandekar : J. Weedon : A. S. Braverman State University of New York, Downstate, 450 Clarkson avenue, Brooklyn, NY 11209, USA e-mail: vaibhavsimla@gmail.com G. Sharma Indra Gandhi Government Medical College, Circular road, Simla, India Ann Hematol DOI 10.1007/s00277-014-2199-5