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Critical Care |

A Rare Case of Fatal Cerebral Venous Thrombosis as a Complication of Iron Deficiency Anemia FREE TO VIEW

Shanley Ignacio, DO; Nikunj Bhatt, MD
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Walter Reed National Military Medical Center, Bethesda, MD


Chest. 2015;148(4_MeetingAbstracts):260A. doi:10.1378/chest.2261092
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Abstract

SESSION TITLE: Critical Care Student/Resident Case Report Posters I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Cerebral venous thromboses (CVT) are an infrequent cause of cerebral vascular accidents and are typically associated with pro-thrombotic conditions.. We describe a rare presentation of cerebral venous thrombosis as a complication of iron deficiency anemia.

CASE PRESENTATION: A 35-year-old previously healthy man presented to the emergency department after being found perseverating over a phone number with concurrent left upper extremity involuntary shaking. One week prior to presentation, the patient described a mild new onset “sinus” headache not fully relieved with over the counter medications. He had no recent trauma, infection, personal or family history of clotting disorder, nor was undergoing any current medical therapies. On exam, he exhibited poor executive function, involuntary, rhythmic left upper extremity jerks, and left achilles clonus. EEG showed simple partial and complex seizures and anti-seizure medications were started. MR imaging revealed an occlusive venous thrombosis in the superior sagittal sinus with bi-frontal venous infarcts. Bloodwork was remarkable only for microcytic anemia with a hemoglobin (Hgb) of 7.9 g/dL, mean corpuscular volume (MCV) of 61 fL, and negative fecal occult blood testing. Of note, the patient had a mild microcytic anemia 1 year prior (Hgb 13.4 g/dL, MCV 76.9 fL). Further testing confirmed severe iron deficiency with serum iron of 13ug/dL, total iron-binding capacity 521ug/dL, and iron saturation of 2.5%. Thorough biochemical testing for hyper-coagulopathy and relevant imaging for malignancy evaluation were negative. During hospitalization the patient had progression of his CVT and shortly after died.

DISCUSSION: Cerebral venous thromboses are a relatively uncommon cause of cerebral vascular accidents. The most common predisposing conditions include oral contraception use, pregnancy/puerperium, pro-thrombotic conditions (ATIII, protein C/S deficiency, anti-phospholipid antibodies, etc), infection, and malignancy [1]. A previous prospective trial has found a small statistical significant association with severe anemias as well described case studies [2]. IDA may predispose patients to thrombus formation by (i) a change in thrombopoeisis regulation, (ii) a secondary thrombocytosis from disinhibited megakaryocyte function, (iii) a change in blood flow turbidity that predisposes patients to clot formation, and/or (iv) a relative increase in platelet contact with endothelial surfaces with loss of RBCs.

CONCLUSIONS: Our case supports iron deficiency anemia as an under recognized cause for cerebral venous thrombosis. Our case study highlights a need to further studies to elucidate the association of iron deficiency anemia and venous clots.

Reference #1: Franchini, Massimo, et al. "Iron and thrombosis." Annals of hematology 87.3 (2008):167-173.

Reference #2: Stolz, Erwin, et al."Anemia as a risk factor for cerebral venous thrombosis? An old hypothesis revisited." Journal of neurology 254.6 (2007):729-734.

DISCLOSURE: The following authors have nothing to disclose: Shanley Ignacio, Nikunj Bhatt

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