Approach to the patogenesis of thrombosis in iron deficiency: Evaluation of coagulation with tromboelastograpahy

UMMARYINTRODUCTION: Iron deficiency (ID) is the most common type of nutritional deficiencyin children. In literature, there are several cases reporting children and adults with thrombosisin relation with IDA. There are also incidence studies showing IDA is more common inpatients with thrombosis compared with the normal population. However, there are noprospective and randomized studies to prove the relationship between IDA and its tendency tofrom thrombosis, or the mechanism of it.PURPOSE: In this study, tromboelastography – which can evaluate coagulation, primary andsecondary hemostasis, and fibrinolytic system- was used to study the correlation between IDAand one of the three factors in Virshow triad-mainly the alterations in the constitution ofblood.METHODS: Blood sampIes from 40 IDA patients at Baskent University Medical facultypediatry clinic were taken for the study group, and was compared with 40 healthy controls.Both the study and control groups were between the ages of 0-18. Blood samples wereevaluated using tromboelastography (TEG ® 5000 Thromboelastograph ® HemostasisAnalyzer) 'plain cup test'. In both groups, reaction time (R), coagulation time (K), alphaangle ((α), maximum amplitude (MA), maximum lysis in minute 30 (LY30), and coagulationindex (CI) which are parameters of tromboelastography, were evaluated.RESULTS: Tromboelastography results of the study and control groups were respectively;(R) 3.9 ± 1,41 and 4.1 ±1,4 min (p: 0,569); (K) 1.45 ± 0,64 and 1.8 ± 1,07 min (p: 0,025);(α) 52.7 ± 8,34 º and 52.7 ± 9,5 º (p: 0,876); (MA) 70.3 ± 5,41 and 66.8 ± 8,2 (p 0,045); (CI)0.96 ±1.47 and 0.26 ± 2,14 (p: 0,12), (LY 30) 3.29±1.47 ve 2.02 ± 2.14 (p: 0,328) .The results of tromboelastography and laboratory parameters showed that as hemoglobindecreases, K time decreases but MA increases. And as heamotocrit decreases and trombocytecount increases, K time decreases. As red cell distribution width (RDW) decreases, K timedecreases but MA and CI increase.CONCLUSIONS: These results showed that in IDA, there is a tendency forhypercoagulation to occur, and the severity of IDA (decreased Hb and Hct, increased RDWand trombocyte count) is positively correlated with the hypercoagulation. According to TEGresults, this coagulation is related to the increased trombocyte function and/or the increase infibrinogen. It also showed there is no deficiency of fibrinogen or factors - FIVI or other in the study group. It also meant thrombocytopenia, trombocyte function deficiency orhyperfibrinolysis were absent. In conclusion, with these laboratory findings, it was provedthat IDA is an underlying cause for thrombosis formation. There is need for more prospectiverandomized studies for determining its pathogenesis.