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Abstract Details

Internal Carotid Artery Thrombus in the Setting of Iron Deficiency Anemia and Thrombocytosis: A Case Series
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
14-007
To describe the clinical presentation, diagnosis, and management of multiple young women with ischemic stroke due to proximal internal carotid artery (ICA) thrombus in the setting of IDA and thrombocytosis, and explore the possible pathophysiological mechanisms linking IDA to ischemic stroke.
Iron deficiency anemia (IDA) is common hematological condition, particularly in patients who menstruate, that is hypothesized to cause a prothrombotic state. The exact mechanism linking IDA to thrombosis is not well understood but may involve increased platelet reactivity, endothelial dysfunction, and altered blood viscosity. The relationship between IDA with reactive thrombocytosis and thrombus formation warrants further investigation.
NA

·       Patient 1: A 44-year-old female with a history of IDA requiring intravenous iron supplementation presented with a left middle cerebral artery (MCA) territory stroke and thrombus in the right proximal ICA. At time of presentation, hemoglobin was 6.7 g/dL and platelets 624 x 10^9/L.

·       Patient 2: A 40-year-old female without previous diagnosis of IDA presented with left MCA stroke and a thrombus in the left common carotid artery/proximal ICA. At the time of presentation, hemoglobin was 7.4 g/dL and platelets 909 x 10^9/L.

·       Patient 3: A 32-year-old female with a history of IDA presented with a right MCA stroke with right M2 occlusion and right ICA nonocclusive thrombus.  At time of presentation, hemoglobin was 7.0 g/dL, platelets 577 x 10^9/L.

All patients were otherwise healthy and had resolution of thrombus following short course of anticoagulation without underlying carotid pathology. Workup for stroke etiology, including testing for myeloproliferative disorders, other hypercoagulable states, malignancy, were negative. All patients received iron supplementation and dedicated management of heavy menstrual bleeding.
This case series highlights an association between ICA thrombus and IDA with thrombocytosis. Clinicians should consider IDA as a potential contributor to stroke risk that requires dedicated diagnosis and treatment.
Authors/Disclosures
Allison Muha, MD (UAB Neurology)
PRESENTER 		Dr. Muha has nothing to disclose.
Mohammad Aladawi, MD Dr. Aladawi has nothing to disclose.
Kristen Sandefer, MD Dr. Sandefer has nothing to disclose.
Jori E. May, MD Dr. May has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Anticoagulation Forum. Dr. May has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for JEM Consulting, LLC.
Ekaterina Bakradze, MD (University of Alabama At Birmingham) Dr. Bakradze has nothing to disclose.