Case Report of International Journal of Case Reports
The multifactorial etiology and approach to iron deficiency anemia in adolescent girls
Lopes, Lisa1; Verlooy, Joris2; Norga, Koen2; van Heerden, Jaques2
1Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Belgium.
2Pediatric Hematology and Oncology, Antwerp University Hospital, University of Antwerp, Belgium.
Iron deficiency anemia (IDA) is a common but underdiagnosed cause of morbidity in adolescent females. Associated thrombocytopenia is rare, but resolves when the anemia is treated with iron supplementation. Menorrhagia is an important cause in the multifactorial etiology and may be familial. This article presents a case of severe anemia and thrombocytopenia in the presence of iron deficiency due to menorrhagia. A holistic approach to IDA is discussed with an approach to the management thereof in adolescent females.
Keywords: Iron deficiency, anemia, adolescent, females
How to cite this article:
Lopes, Lisa; Verlooy, Joris; Norga, Koen; van Heerden, Jaques. The multifactorial etiology and approach to iron deficiency anemia in adolescent girls. International Journal of Case Reports, 2020 4:130. DOI: 10.28933/ijcr-2020-04-0505
1 Vos T et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013 findings from the global burden of disease 2013 study. JAMA Pediatr 2016;170(3):267-87.
2 Gergerding J et al. Iron deficiency – United States, 1999–2000. MMWR. Morb Mortal Wkly Rep 2002;51(40):897-901.
3 Camaschella C. Iron-deficiency anemia. N Engl j Med 2015; 372:1832–43.
4 Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol 2017; 40:55-67.
5 De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD. Iron deficiency anemia in adolescents: A literature review. Nutr Hosp 2014 ;29(6):1240-9.
6 Ibrahim R et al. Triad of iron deficiency anemia, severe thrombocytopenia and menorrhagia: A case report and literature review. Clin Med Insights Case Rep 2012; 5:23-7
7 Morris VK, Spraker HL, Howard SC, Ware RE, Reiss UM. Severe thrombocytopenia with iron deficiency anemia. Pediatr Hematol Oncol 2010;27(5):413-9.
8 Perlman MK, Schwab JG, Nachman JB, Rubin CM. Thrombocytopenia in children with severe iron deficiency. J Pediatr Hematol Oncol 2002;24(5):380-4.
9 McDonald TP, Clift RE, Cottrell MB. Large, chronic doses of erythropoietin cause thrombocytopenia in mice. Blood 1992; ;80(2):352-8.
10 Karpatkin S, Garg SK, Freedman ML. Role of iron as a regulator of thrombopoiesis. Am J Med 1974; ;57(4):521-5.
11 Berger M, Brass L. Severe thrombocytopenia in iron deficiency anemia. Am J Hematol 1987; 24(4):425–8.
12 Powers JM, Stanek JR, Srivaths L, Haamid FW, O’Brien SH. Hematologic considerations and management of adolescent girls with heavy menstrual bleeding and anemia in US children’s hospitals. J Pediatr Adolesc Gynecol 2018; ;31(5):446-450.
13 Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron deficiency anemia in adolescents who present with heavy menstrual bleeding. J Pediatr Adolesc Gynecol 2017;30(2):247-250.
14 Mesías M, Seiquer I, Navarro MP. Iron nutrition in adolescence. Crit Rev Food Sci Nutr 2013;53(11):1226-37.
15 Friberg B, Kristin Örnö A, Lindgren A, Lethagen S. Bleeding disorders among young women: A population-based prevalence study. Acta Obstet Gynecol Scand 2006; ;85(2):200-6.
16 Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol 2017, ;30(3):335-340.
17 Kasper CK, Whissell DYE, Wallerstein RO. Clinical aspects of iron deficiency. JAMA J Am Med Assoc 1965; ;191(5):359-363.
18 Kiem J et al. Elemental composition of platelets. Part II. Water content of normal human platelets and measurements of their concentrations of Cu, Fe, K, and Zn by neutron activation analysis. Clin Chem 1979; ;25(5):705-10.
19 Verma V et al. An analysis of the relationship between severe iron deficiency anemia and thrombocytopenia. Ann Hematol 2015; 94:535-7.
20 Polette A, Blache D. Effect of vitamin E on acute iron load-potentiated aggregation, secretion, calcium uptake and thromboxane biosynthesis in rat platelets. Atherosclerosis 1992;96(2-3):171-9.
21 Barradas MA, Jeremy JY, Kontoghiorghes GJ, Mikhailidis DP, Hoflbrand AV, Dandona P. Iron chelators inhibit human platelet aggregation, thromboxane A2 synthesis and lipoxygenase activity. FEBS Lett 1989; ;245(1-2):105-9.
22 Taymor ML, Sturgis SH, Yahia C. The etiological role of chronic iron deficiency in production of menorrhagia. JAMA J Am Med Assoc 1964 ;187:323-7.
23 De Falco L et al. Review articles: Iron refractory iron deficiency anemia. Haematologica 2013; 98(6):845–53.
24 Donker AE et al. Iron refractory iron deficiency anemia: A heterogeneous disease that is not always iron refractory. Am J Hematol 2016;91(12): E482-E490.
25 Donker AE et al. Practice guidelines for the diagnosis and management of microcytic anemias due to genetic disorders of iron metabolism or heme synthesis. Blood 2014;123(25):3873-86.
26 Kuzmina N, Palmblad J, Mints M. Predictive factors for the occurrence of idiopathic menorrhagia: Evidence for a hereditary trait. Mol Med Rep 2011; ;4(5):935-9.
27 Baker RD et al. Clinical report: Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 2010;126(5):1040-50.
28 The American Obsterics and Gynecologists. ACOG practice bulletin no. 95: Anemia in pregnancy. Obstet Gynecol 2008; 112(1):201.
29 Short MW, Domagalski JE. Iron deficiency anemia: Evaluation and management. Am Fam Physician 2013;87(2):98-104.
30 Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics 2015;136(4):746-52.
31 McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C, Screening and routine supplementation for iron deficiency anemia: A systematic review. Pediatrics 2015;135(4):723-33.
32 American Academy of Pediatrics. Adolescence visits. In: Bright futures: Guidelines for health supervision of infants, children, and adolescents, 2017. https://brightfutures.aap.org. Accessed June 2019.
33 Broome C, et al. Recommendations to prevent and control iron deficiency in the United States: Centers for Disease Control and Prevention. MMWR Recomm Rep 1998.
34 National Institute for Health and Care Excellence. Heavy menstrual bleeding: Assessment and management. Clin Guidel 2007.
35 Orkin S. Nathan and Oski’s hematology and oncology of infancy and childhood, 8th ed. Philadelphia, 2015.
36 World Health Organisation. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. www.who.org Accessed October 2019.
37 Pasricha SRS et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust 2010;193(9):525-532.
38 Sills R, Iron-deficiency Anemia, Part XXI, Diseases of the blood, Ch455, p2323, Nelson’s textbook of pediatrics (20th edn.), by R. Kliegman, B. Stanton, J. St. Geme, N. Schor (eds), Elsevier, Philadelphia, 2016.
39 Stein, J., Hartmann, F. & Dignass, A. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol 2010; 7(11):599–610.