From the Guidelines
Yes, anemia can definitely coexist with thrombocytosis, as evidenced by the complex interplay of various conditions that can lead to both decreased red blood cell count and increased platelet count. This combination can be seen in certain clinical scenarios, such as myeloproliferative neoplasms, where supportive care measures including transfusion support, iron chelation, and cytoreductive therapy may be necessary 1. The relationship between anemia and thrombocytosis can be attributed to various factors, including decreased iron availability, chronic inflammation, and malignancies.
Some key points to consider when evaluating a patient with both anemia and thrombocytosis include:
- Determining whether the thrombocytosis is reactive or primary, as this can guide treatment decisions
- Addressing the underlying cause of the anemia, such as iron deficiency, which can often normalize both the hemoglobin and platelet count simultaneously
- Considering the use of cytoreductive therapy, such as hydroxyurea, for thrombocytosis or leukocytosis, as recommended in the NCCN guidelines 1
- Providing supportive care measures, including transfusion support, iron chelation, and antibiotic prophylaxis, as needed
In terms of treatment, focusing on the underlying cause of the anemia and thrombocytosis is crucial, and may involve a combination of supportive care measures and cytoreductive therapy. For example, iron supplementation may be necessary for patients with iron deficiency anemia, while cytoreductive therapy may be required for patients with primary thrombocytosis. Overall, a comprehensive approach to managing anemia and thrombocytosis is essential to improve patient outcomes and quality of life.
From the Research
Anemia and Thrombocytosis Coexistence
- Anemia can coexist with thrombocytosis, as evidenced by several case reports and studies 2, 3, 4, 5.
- Thrombocytosis is a common disorder in patients diagnosed with iron deficiency anemia, and in some cases, it can be severe 3, 5.
- The exact mechanism of the occurrence of thrombocytosis in iron deficiency anemia remains unclear, but it is thought to be related to the body's response to chronic blood loss or inflammation 3.
Case Reports and Studies
- A case report of a 40-year-old woman with iron deficiency anemia, menorrhagia, and thrombocytopenia (not thrombocytosis) highlights the complex relationship between iron deficiency and platelet counts 2.
- Another case report of a young woman with severe anemia and thrombocytosis associated with celiac disease demonstrates that thrombocytosis can occur in the context of iron deficiency anemia 3.
- A study of refractory anemia with ring sideroblasts and thrombocytosis (RARS-T) suggests that this rare disease may be a distinct clinicopathological entity, but its diagnosis and treatment are still debated 4.
- A case report of a 21-year-old woman with severe thrombocytosis and leukocytosis associated with iron deficiency anemia highlights the potential for severe thrombocytosis in this context 5.
Diagnostic Criteria and Borderline Cases
- The diagnostic criteria for myelodysplastic/myeloproliferative neoplasms with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T) include refractory anemia, but some cases without anemia have been identified, challenging the requirement of anemia as a diagnostic criterion 6.
- These borderline cases suggest that the spectrum of MDS/MPN-RS-T may be broader than previously thought, and that anemia may not be a necessary feature of the disease 6.