Iron deficiency anemia and reactive thrombocytosis in a woman with heavy menstrual bleeding: A case report

Abstract

Thrombocytosis is frequently encountered in clinical practice and requires a rigorous diagnostic approach to accurately determine its underlying cause. It could be primary, such as essential thrombocythemia (ET), or secondary to chronic inflammation, hemorrhage, or iron deficiency anemia (IDA). Herein, a 32-year-old woman was initially diagnosed with ET and treated with cytoreduction and an antiplatelet agent. Despite this, her erythrocyte counts increased, accompanied by microcytic hypochromic anemia. Laboratory tests and detailed clinical reassessment ultimately identified IDA secondary to polymenorrhagia as the cause of her anemia. Iron supplements, along with the absence of an iron deficiency trigger, improved her hematologic parameters. She was subsequently reclassified as a case of IDA with reactive thrombocytosis. Misdiagnosis led to improper management and treatment of IDA. This case highlights to clinicians that thrombocytosis is mainly secondary to an underlying trigger, and the definitive diagnosis of the rare ET requires fulfilment of the well-established criteria.