Abstract

Background: Iron deficiency is the most common cause of anemia worldwide. In premenopausal women, iron deficiency anemia is commonly caused by chronic heavy vaginal bleeding (menorrhagia). Iron deficiency anemia is usually associated with either normal or high platelet counts. However, it is rarely reported with low platelet counts. The presentation of menorrhagia, iron deficiency anemia, and thrombocytopenia has been rarely reported in the literature. The present report discusses the management and outcome of the unusual presentation of menorrhagia, iron deficiency, and thrombocytopenia. 
Case presentation: A 20-year-old female presented with a history of menorrhagia for two months, severe anemia, and thrombocytopenia. The laboratory investigations confirmed a severe iron deficiency anemia which was secondary to menorrhagia. After excluding other causes of thrombocytopenia, it was attributed to iron deficiency anemia. She was treated with packed red blood cell transfusion and oral iron therapy. Surprisingly, she had a further decline in platelet count then the count improved. Two weeks later, she had a further rebound thrombocytosis. During follow-up, and then the patient recovered completely, and all her hematological parameters returned to normal values. 
Conclusion: Iron  deficiency  anemia-associated  thrombocytopenia  is  an  underrepresented  cause  of  thrombocytopenia. This  case  highlights  the  importance of  considering iron deficiency-associated  thrombocytopenia  in  the  differential  diagnosis  to  avoid  the  use  of  unnecessary  investigations  and  treatment. Menorrhagia  can  cause  iron  deficiency  anemia  which  can  be  associated  with  thrombocytopenia. Iron  therapy  can  help  to  treat  menorrhagia, iron deficiency anemia, and thrombocytopenia and it should be considered in the management of such patients.                                                                                

Keywords

Vaginal bleeding, Iron deficiency anemia, Menorrhagia, Thrombocytopenia, Saudi Arabia.  

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