Isolated Ulnar Artery Occlusion with Concurrent Internal Jugular Vein Thrombosis in Severe Iron-Deficiency Anaemia.

INTRODUCTION

Severe iron deficiency anaemia (IDA) is increasingly recognized as a cause of a reversible hypercoagulable state, although simultaneous arterial and venous thrombosis are rare. Several mechanisms have been proposed, including reactive thrombocytosis, endothelial dysfunction, and changes in erythrocyte rheology, which may be secondary to reduced tissue oxygenation.

CASE DESCRIPTION: We report the case of a 41-year-old woman with chronic menorrhagia due to fibroids who developed digital cyanosis and neurologic deficits due to severe microcytic anaemia (Hb 6.7 g/dl), associated with severe iron deficiency and mild thrombocytosis (442 ×109/l). She was discharged after blood transfusion with therapy for Raynaud phenomenon (amlodipine) but returned to the emergency room due to an acute right ulnar artery occlusion complicated by internal jugular vein thrombosis that was managed with embolectomy and anticoagulation. Her digital function fully recovered, and she remained free of thrombophilia.

CONCLUSION

Our case highlights the potential for severe IDA to cause both arterial and venous thrombosis, even in the setting of only modest platelet elevations. Chronic tobacco use may have contributed to her presentation, and clinicians should remain aware of the possibility of thrombosis in patients presenting with severe IDA who do not have other known pro-thrombotic conditions.

LEARNING POINTS: Severe iron deficiency anaemia can cause both arterial and venous thrombosis even in the setting of only mildly elevated platelet count, so platelet count alone should not be used as a determinant for thrombotic risk.Painless discoloration of the digits with diminished or non-existent pulse on examination in a young patient with no vascular risk factors requires vascular imaging prior to arriving at a diagnosis of Raynaud phenomenon, as the presentation can mimic acute arterial occlusion and require urgent intervention.A negative workup for thrombophilia and autoimmune disease cannot be used to rule out the possibility of a prothrombotic state, as severe iron deficiency anaemia can act as a prothrombotic trigger.