Abstract Details

Title Iron Deficiency Anemia with Reactive Thrombocytosis Associated with Internal Carotid Artery Thrombus and Ischemic Infarction

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-004

Objective To observe the association of iron deficiency anemia and carotid artery thrombus formation with acute stroke in a patient population without any coexisting risk factors for vascular disease.

Background

Detection of carotid artery thrombi without identifiable carotid vascular disease is rare. The association of iron-deficiency anemia (IDA) and carotid artery thrombus formation with acute stroke is infrequently recognized. We describe five cases of IDA and reactive thrombocytosis with associated internal carotid artery thrombus resulting in acute cerebral infarction.

Design/Methods Prospective data from 2015 – 2021 in our Comprehensive Stroke Center’s database were analyzed. Acute stroke patients with anemia (hemoglobin <12 gms/dL), low serum Iron, presence of symptomatic cervical internal carotid artery thrombus seen on vessel imaging, and thrombocytosis (platelet count >440 k/cumm) were identified. Patients with other causes of carotid thrombosis such as underlying vessel dissection, hypercoagulable state, and atherosclerotic plaque rupture/embolism were excluded.

Results We identified five patients with acute infarcts secondary to IDA and reactive thrombocytosis. All patients were female, with an average age of 41.8 years. All except one patient were African American with history of smoking. Systemic anticoagulation was used in two patients; dual antiplatelet treatment (aspirin and clopidogrel) followed by aspirin monotherapy was used in one patient, and aspirin alone was used in two patients. All patients received iron supplementation. Follow-up radiographic imaging demonstrated resolution of thrombus in four out of five patients and no identifiable vascular disease. None of the patients had other causes for hypercoagulability.

Conclusions IDA and reactive thrombocytosis can lead to carotid thrombosis and secondary acute ischemic stroke, especially in young African American women. Medical management with anticoagulant or antiplatelet medications, and iron replacement leads to resolution of thrombus in most cases. We report the largest series of such patients to date.

Authors/Disclosures
Ashley Nelson, DO (University of Rochester Medical Center/Strong Memorial Hospital) PRESENTER	Dr. Nelson has nothing to disclose.
Cassie L. Nankee, MD (UW Hospitals and Clinics)	Dr. Nankee has nothing to disclose.
Chirantan Banerjee, MD, MPH (Medical University of South Carolina)	Dr. Banerjee has nothing to disclose.

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