Why High Platelets Count (Thrombocytosis) with Iron Deficiency Anemia IDA (What do High Platelets Low Hemoglobin Low Iron mean?)

Can platelets be high because of low iron anemia?

Yes, platelets could be elevated secondary to low iron and low hemoglobin levels (the medical term is iron deficiency anemia, abbreviated IDA) but the too much amount of platelets isn’t due to a disease in platelets itself but as a complication of IDA, please continue reading to understand that…

Low iron in the blood does not directly affect the platelets level in the blood, that’s because the platelets don’t need iron to proliferate in the bone marrow but the RBCs need the iron in the differentiation step, therefore the RBCs decrease if the iron is low but the platelets increase if the iron is low. got it?

Get to know what is anemia type you have?

Understand high platelets in sickle cell anemia

Why the bone marrow may not work normally so it makes too many platelets and low RBC?

Insufficient iron in the blood will slow down the hematopoiesis “the process of making the blood cells in the bone marrow”, and results in low RBC and Hemoglobin, thus the bone marrow tissue produce too much platelets in the account of red cells, therefore, uncontrolled number of Platelets in CBC test. How to read CBC test?

So what is the reason behind the increasing production of platelets in the blood even though the iron amount needed to make cells is scarce?

Because the type of cells from which platelets and red blood cells originate are one, which is “the myeloid”, if the production of red blood cells decreases, all the production capacity will be directed to the second type, which is platelets, as in the picture below shows that both red blood cells and platelets originate from the same cell of origin which interpret why they are produced in that relative way.

 understand the plt and rbc have the same origin
Illustration for the hematopoietic process inside bone marrow showing how RBCs and PLTs share the same origin

in the image, notice that red line arrows, demonstrate that myeloid cell divides into red cells and platelets’ mother then it divided into platelets fragments.

Do you know what’s RBC in blood test?

What Causes High Platelets Count in Iron Deficiency Anemia?

The commonest reason for thrombocytosis subsided after Iron Deficiency Anemia is the low iron diet, or your may have inflammation in the stomach or intestines that block them from absorbing the digested iron-rich-food, chronic kidney disease is one example too, irregular menstrual bleeding and pregnancy are of conditions that consume plenty of iron thus the blood cells lack of iron and lead to IDA, therefore the platelets count is increased and appear as “platelets high” in the lab report.

If the Iron stores in the liver deplete due to current or ongoing inflammation, the free iron in the blood will dramatically decreased and also become unavailable for blood cell’s making. Ferritin blood test is recommended in such cases.

Can iron supplements cause high platelets?

No, the opposite is true. To explain that you may know that the scientific fact is the low iron will elevate the platelets level in the blood, on the contrary, adding iron to the blood by using the drugs that enhance the blood level of iron surely will adjust the iron to the normal level and also will induce blood platelets to return to their normal level and even it’s possible to make the platelet level decline and become less than the normal level as well, and thus a transient thrombocytopenia “low platelets” occurs after iron supplementations.

What is the Platelets level in the iron deficiency Anemia?

Platelets count is the blood test may go as high as 900,000 if you are severely anemic of iron deficiency, the reasons is that lack of iron will redirect the bone marrow to produce plenty of platelets while RBC production is reduced, that’s medically called “iron–deficient erythropoiesis” and induce “megakaryopoiesis”.
However, as the IDA progresses the bone marrow may produce plenty of platelets that appear higher than normal range in the blood test but the resultant platelets may be larger than normal size and showed enhanced aggregation which means the elevated platelets in the IDA do not necessarily doing their normal required function.

You may want to understand what does the word “anemic” mean?

What does it mean by platelets with enhanced aggregation?

The main function of platelets is to adhere to make a plug formation whenever a vessel injured which called “the platelets aggregation function” or “platelets reactivity”, but if the platelets increase in count, they will consequently increase in adhering potential leading to “enhanced aggregation” which may increase the risk of arterial thrombosis (blood clot risk) or other cardiovascular diseases.

Can I have IDA and my platelets be normal and not elevated?

Yes, it can be happening to have mild decreased iron levels and Anemia that don’t impact the platelets level too much, it means your platelets count still inside the normal limits in the blood test results during the Anemia that is due to insufficient iron in the blood. Suggested reason is the large reference range of normal platelets levels “140-400” which allow the blood to interact normally without being an issue on the platelets count at the end, thus unless iron reduction goes worse, platelets will not exceed the maximum normal number in a healthy person.

Another reason is the false results of platelets count, yes, it can be happen that your count is normal in real while the lab reports it as high, possibly because unexpected error in sampling or instruments or unexperienced technicians.

However, the red blood cells in iron deficiency anemia is smaller than than the normal size thus the automounting machines may falsely count the small red cell as platelet because the platelets are smaller than red cell, therefore the blood count test reveal elevated count of platelets while it’s normal indeed.

Incorrect blood sampling may lead to hemolysis of red blood cells which impact on the final count of RBCs and PLT, thus CBC reveals incorrect platelets count which indeed fragmentation of shed red cell, also, formation of small clots in the sample can be a reason to lower platelets than the actual count.

How do you know the platelets count is correct? if the “AGG” flag is on the platelets number then it’s indication of sampling or instrumental errors and must repeat the platelets blood test.

Symptoms of High Platelets in patients with Iron Deficiency Anemia

How do you feel if your platelets count is elevated with anemia of low iron?

Because the high platelets level (thrombocytosis) is a second effect of low iron, it’s rare to complain from thrombocytosis symptoms, instead you may feel the symptoms of the Iron deficiency anemia which may include:

  • Extremely exhausted, tired and feeling Weakness.
  • Headache, low concentration, dizziness or lightheadedness.
  • Pale and dry skin, Cold hands and feet.
  • Chest pain and heart palpitations (fast heartbeat or shortness of breath).
  • Some rare complications such as Brittle nails, soreness of your tongue.
  • Increased risk for infections

Examples of blood test results following the elevated platelets and IDA

Besides the low iron, anemia, and the platelets high count also the IDA impact on the other blood test results as shown below:

  • Low iron “about 10, normal range 40–100 “
  • Low Ferritin (iron stores blood test) ” less than 90, normal range 10–200″
  • Low Hemoglobin level “less than 11.0, normal range is 11–18”
  • High or Normal TIBC “greater or equal to 450, normal range 240–450 mcg/dL)
  • Low Red blood cells “less than 4.5–6.0, normal RBC levels
  • High Platelets “above 450,000, normal range 140,000–450,000)
  • MPV and PDW may be normal or decreased in IDA and elevated platelets count.
  • Normal not elevated PT time and INR

That is the diagnostic pattern of blood test results that is characteristic to the IDA and high platelets, however if you complain from another ailment, your lab results will probably impact as well. That was the examples of negative effects of low iron levels on other lab tests.

Explaining the lab report codes near of the platelets count such as:

  • The flag “A” which means abnormal platelets count
  • The flag “H” next to Platelets number which means high platelets count, or elevated the normal limit.
  • The flag “*” which indicate that the platelets count is not accepted and must retest again.
  • “outside range”, a flag indicate that platelets count in the CBC test exceeded the known normal limit which is abnormal.
  • The abbreviation “AGG” which indicate abnormal clumps of platelets in the sample and the lab must recount platelets again before reporting the final count to the patient.
  • The Abbreviation “PLT” stands for “Platelets”.

You may want to understand lab codes and flags

What do lab test results mean in this case?

Low iron means followed by high count of platelets in the CBC test can indicate abnormal platelets production due to insufficient iron which impacts on manufacturing of red blood cells in bone marrow, just that benign increase which usually resolve and stabilize on its own just after the resolution of low iron and low hemoglobin.

A simple chart explaining how low iron anemia affects platelets count in the blood
A simple chart explaining how low iron anemia affects platelets count in the blood

But, high platelets count (thrombocytosis) with low hemoglobin and low iron (IDA) doesn’t mean cancer, malignancy, or other serious diseases unless other investigations and scanning report that.

How does iron help in the production of platelets?

Most anemia (50%) in all the world is IDA; while the rest (50%) of anemia reasons are infectious and inflammatory diseases (especially malaria), blood loss from parasitic infections, and other nutrient deficiencies (vitamin A, riboflavin, folic acid, and vitamin B12). The possible reason for IDA in children is the iron deficiency that often coexists with lead intoxication, to understand that you may know that the competition of several other heavy metals may share the iron intestinal absorption pathway. e.g. lead, manganese, cobalt, and zinc. This interaction may produce serious medical complications in children

Can low iron level affect your platelets count?

Definitely yes, because most patients with iron deficiency anemia will have normal or increased blood platelet counts to the extreme degree (alot of platelets in the bloodstream without a necessity), some platelet counts may go higher than 1,000 × 109/L at the time of late diagnosis.

If you have IDA, which high or low platelets will occur?

Thrombocytosis (high count of platelets test) is the most common complication of low iron, nevertheless, thrombocytopenia in association with iron deficiency is relatively rare.

The factors that lead to platelets elevation if you have anemia of iron deficiency

Low Iron and Low transferrin saturation results are of reasons behind too much blood platelets in the test results. Transferrin saturation to be normal must be between 35.5% and 44.9% for women and 38.3% to 48.6% for men. Low iron and transferrin levels means that there is insufficient iron in the blood and the protein bind to and transferring the iron has too many places that is empty and need iron molecules to bind to it.

Is the level of platelets in the blood directly or inversely proportional to the level of iron deficiency anemia in the blood?

Platelets level in the blood is inversely proportional to the ID anemia, that’s because low iron will prevent the red blood cells from being produced in sufficient numbers while induce the bone marrow to make too much unwanted platelets, therefore, the more severe and hypo-chronic (prolonged reduction) anemia has higher platelet count

Why do Inflammation causes Iron deficiency anemia and elevated platelets?

Inflammation considered as an obstacle to the complete absorption of iron, also the IL-6 and other inflammatory proteins increase in reaction to inflammatory process which works like a concern for the body’s systems, thus the body works to stop inflammation instead of carrying out the vital processes required for its growth and prosperity, and also inflammation causes the body to divert all its resources to the process of stopping the cause of inflammation, which reduces the resources needed for the body maintenance and growth. Hence the reasons that make iron reduces in the blood, thus iron will not reach the bone marrow tissue to form red blood cells, so anemia (IDA) will occur, and as a result, the platelets will increase in the FBC test (Thrombocytosis), which may harm the body instead of benefiting it.

How does iron deficiency affect hematopoiesis and elevate platelets?

Why do you get elevated platelets count (thrombocytosis) with iron deficiency?

Looking at the picture that explains the sequence of blood formation from the beginning inside the bone marrow tissue (above), it turns out that:

There’s the first step which called “haematopoietic transition of the endothelial” where the iron has no concern with it, thus the blood cells continue through this stage to grow and differentiate into two main types, the “Lymphoid” which is the precursor of lymphocytes that fight viruses, and the second type “Myeloid” which the progenitor for production of most of other cells including the Platelets and RBCs.

Second step is where the “Myeloid” subdivided into many cells, one of them is the red blood cells “Erythrocyte” that consume huge amount of “iron” to synthesize the protein “Heme” in the hemoglobin molecule, Hemoglobin is the reddish fluid fills the red blood cell and consists of many iron atoms, iron inside the hemoglobin plays important role in binding to other nutrients and oxygen to transport them to the other tissues.

Therefore, if there’s no iron is available in the bone marrow, the RBCs only is what will stop or reduce proliferating, next consequence is that the bone marrow will produce other cells in the “Myeloid” that don’t need iron in the production process, therefore the bone marrow abnormally producing plenty of unneeded platelets, and alot of Neutrophils, Basophils, Eosinophils, and Monocytes.

Also, the cloned RBCs when the blood lacks the iron will be smaller in size (Anisocytosis) which means less effective in carrying oxygen and will live shorter which induce bone marrow to harry up to compensate, thus a test called reticulocyte count will be a good indicator of bone marrow compensation.

What’s reticulocyte count stands for? And what does high retics indicate?

The word reticulocyte stands for “the blood cell that looks a netlike under microscope” and abbreviated “Retic count” in the laboratory, the reticulocyte is an immature cell that preceding the adult red blood cell, Retic count test reporting what’s the percentage of the retics cells in the whole red blood cells count in the blood sample, the more retics cell the more immature production of blood cells from bone marrow which is considered a good indicator that there’s a reasons rushes the bone marrow to release abundance of RBCs even they still immature, of course this can lead to a miss.

Thus, severe IDA can lead to high retics percentage in the red blood cells which draws the doctor’s attention that the patient needs a fresh blood transfusion instead of his deficient-blood, which has become sick and full of immature blood cells.

What’s ansiocytosis and poikilocytosis?

They’re medical terms for abnormal morphology (size and shape) of blood cells, usually used to describe that there are more than one definite size and shape of red blood cells in the blood.

Well, is high white blood cells (WBCs) and too much Platelets because of IDA or inflammation?

Increased Granulocytes count and platelets count in the presence of low hemoglobin (in case of iron def. anemia) may thought it is because of a current inflammatory response (inflammation) but the actual reason may be the Anemia of iron deficiency.

In general, it’s of natural surviving response, when the blood doesn’t have enough normal blood cells it compensates by releasing too much blood cells into the blood stream, but why the platelets increased during anemia due to imbalance in bone marrow.

You may want to know the meaning of high WBC and high PLT

I am pregnant has iron deficiency anemia and my lab tests show platelets high, wat does this mean?

It’s very common to find low hemoglobin and low iron results (IDA) during the pregnancy months, as well as the decrease in calcium, vitamin B12, folate, and other minerals and vitamins, the typical reason is that the fetus body consume huge amount of nutrients to build and grow, the vast withdrawing of iron especially in the late months of pregnancy usually causes reactive or secondary thrombocytosis (platelets count above the normal limit without a platelets illness), but you shouldn’t be concerned because the increased platelets level (may go up to 900,000 while the normal is up to 450,000) will not hurt the baby and can be reversible but the pregnant woman must follow-up regularly to avoid any unexpected complications, that’s it.

Understand more about hCG level, the pregnancy hormone

Should I worry about elevated platelets if I have Iron deficiency Anemia?

When should I worry about platelets high count following low iron anemia?

Priority is the treatment of iron deficiency anemia at first which is usually simple then platelets count will turn back normal within few days even in its own without specific medicine for thrombocytosis.

Elevated platelets if followed the low iron anemia isn’t a concern if there’s no other disease and may resolved in a matter of days but with regular treatment and following the doctor’s instruction well.

Take into your account, After spleen removal platelets may go down after two months, understand elevated platelets count after splenectomy

High platelets and no IDA, what does that mean?

It is possible that your lab results show elevated platelets count but you don’t have anemia or low iron, that’s is common because there’re many other reasons to increase the blood platelets in absence of IDA and anemia, in this post we tried to explain the causes of thrombocytosis following IDA from many different angles, if you didn’t find what you are looking for please just register account, post new question to get instant response and follow to learn more.

Dr.Megan Ralf

A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.

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