Differential Diagnosis for Recurrent Thrombocytopenia and Persistent Low Iron
Single Most Likely Diagnosis
- Chronic Blood Loss: This is the most straightforward explanation for both recurrent thrombocytopenia (due to consumption of platelets in clot formation) and persistent low iron (due to loss of iron-rich red blood cells). Common sources include gastrointestinal bleeding, menstrual bleeding in women, or other occult bleeding sites.
Other Likely Diagnoses
- Iron Deficiency Anemia with Thrombocytopenia: Iron deficiency can lead to a decrease in platelet production, and chronic anemia can also contribute to thrombocytopenia due to bone marrow compensation mechanisms.
- Chronic Disease: Conditions like chronic kidney disease, liver disease, or chronic infections can lead to both anemia (often normocytic but can be microcytic due to iron deficiency) and thrombocytopenia due to inflammation, bone marrow suppression, or splenic sequestration.
- Splenomegaly: An enlarged spleen can sequester both red blood cells and platelets, leading to anemia and thrombocytopenia. Causes include portal hypertension, lymphoma, or other infiltrative diseases.
Do Not Miss Diagnoses
- Hemophagocytic Lymphohistiocytosis (HLH): A rare but life-threatening condition characterized by excessive immune activation, leading to phagocytosis of blood cells, including platelets, and potentially severe anemia. It requires prompt recognition and treatment.
- Thrombotic Thrombocytopenic Purpura (TTP): A disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms. It is caused by a deficiency in ADAMTS13, a von Willebrand factor-cleaving protease.
- Bone Marrow Failure Syndromes: Conditions like aplastic anemia or myelodysplastic syndromes can lead to both anemia and thrombocytopenia due to bone marrow failure to produce blood cells.
Rare Diagnoses
- Thrombocytopenia-Absent Radius (TAR) Syndrome: A rare genetic disorder characterized by thrombocytopenia and bilateral absence of the radius bone. Anemia may be present due to associated complications.
- Congenital Dyserythropoietic Anemias: A group of rare genetic disorders affecting erythropoiesis, leading to anemia. Some forms may also have associated thrombocytopenia.
- GATA2 Deficiency: A rare genetic disorder that affects hematopoiesis, leading to conditions like monocytopenia and mycobacterial infection susceptibility, and can also present with thrombocytopenia and anemia.