Korean J Hematol.  2009 Dec;44(4):336-340. 10.5045/kjh.2009.44.4.336.

A Case of Deep Vein Thrombosis Following Iron Deficiency Anemia in Cerebral Palsy

• Park JE
• Cho YJ
• An SA
• Hwang HS
• Lee SY
• Chung SY
• Jeong DC

• KMID: 2252124
• DOI: http://doi.org/10.5045/kjh.2009.44.4.336

Abstract

Thrombotic complications in iron-deficiency anemia (IDA) are rare. We now report a case of deep vein thrombosis following iron deficiency anemia in cerebral palsy. A 20 year old male was admitted to our hospital? due to a pale appearance. He was diagnosed as having spastic cerebral palsy. On admission, a complete blood cell count showed IDA with thrombocytosis. Prothrombin time and activated partial thromboplastin time were within the normal range. We observed swelling and edema on the left thigh and ankle without tenderness. We performed Doppler sonography and computed tomography. Thrombi were located in the left common iliac vein and left superficial femoral vein with elevated D-dimer levels. We started heparin therapy. We excluded intravascular hemolysis or a hypercoagulable state when we found that Ham's test, anti-cardiolipin antibody, and lupus anticoagulant were negative. The patient died due to hypoxemia and cardiac failure despite ventilator care with anti-coagulant therapy.

Keyword

Iron deficiency anemia; Deep vein thrombosis; Spastic cerebral palsy

MeSH Terms

Anemia, Iron-Deficiency
Animals
Ankle
Anoxia
Blood Cell Count
Cerebral Palsy
Edema
Femoral Vein
Fibrin Fibrinogen Degradation Products
Heart Failure
Hemolysis
Heparin
Humans
Iliac Vein
Iron
Lupus Coagulation Inhibitor
Male
Partial Thromboplastin Time
Prothrombin Time
Reference Values
Thigh
Thrombocytosis
Venous Thrombosis
Ventilators, Mechanical
Fibrin Fibrinogen Degradation Products
Heparin
Iron
Lupus Coagulation Inhibitor

Figure

• 

  Fig. 1. Thrombi on the left common iliac vein on Doppler ultrasonography. There were shown heterogenous echogenic density of thrombi (arrow) on left common iliac vein.

• 

  Fig. 2. The distribution of thrombi on venous phase of computerized tomography. There were shown thrombi (arrow) on the left common iliac vein (A) and the left superficial femoral vein (B).

Reference

References

1. Chan AK, Deverber G, Monagle P, Brooker LA, Massicotte PM. Venous thrombosis in children. J Thromb Haemost. 2003; 1:1433–55.

2. Andrew M, David M, Adams M, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian registry of VTE. Blood. 1994; 83:1251–7.

3. Schloesser LL, Kipp MA, Wenzel FJ. Thrombosis in iron-deficiency anemia. J Lab Clin Med. 1965; 66:107–14.

4. Hartfield DS, Lowry NJ, Keene DL, Yager JY. Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol. 1997; 16:50–3.

5. Keung YK, Owen J. Iron deficiency an thrombosis: literature review. Clin Appl Thrombosis/Hemostasis. 2004; 10:387–91.

6. Sandoval C. Thrombocytosis in children with iron deficiency anemia: series of 42 children. J Pediatr Hematol Oncol. 2002; 24:593.

7. Bilic E, Bilic E. Amino acid sequence homology of thrombopoietin and erythropoietin may explain thrombocytosis in children with iron deficiency anemia. J Padiatr Hematol Oncol. 2003; 25:675–6.

8. Tekin D, Yavuzer S, Tekin M, Akar N, Cin S. Possible effects of antioxidant status on increased platelet aggregation in childhood iron-deficiency anemia. Pediatr Int. 2001; 43:74–7.

9. Kwon SB, Lee BC, Bae JC, Hwang SH, Choi WC. MCA territorial infaction with iron deficiency anemia and thrombocytosis. J Korean Neurol Assoc. 1998; 16:63–6.

10. Jung PW, Hong SC, Lee KH, Chung CS. A case of deep cerebral venous thrombosis associated with iron deficiency anemia. J Korean Neurol Assoc. 1999; 17:713–6.

11. Sandoval JA, Sheehan MP, Stonerock CE, Shafique S, Rescorla FJ, Dalsing MC. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008; 47:837–43.

12. Benedict SL, Bonkowsky JL, Thompson JA, et al. Cerebral sinovenous thrombosis in children: another reason to treat iron deficiency anemia. J Child Neurol. 2004; 19:526–31.

13. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997; 350:1795–8.

14. Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006; 175:1087–92.

15. Franchini M, Targher G, Montagnana M, Lippi G. Iron and thrombosis. Ann Hematol. 2008; 87:167–73.