Quantitative, morphological, and functionalplatelet changes in iron deficiency anemia

Abstract

Summary. Introduction. Iron is one of the most important factors regulating hematopoiesis. Today there are numerous data on the effect of
iron on erythroand leukopoiesis. However, the data of iron role on platelet formation are scarce. Iron effects on megakaryocyte differentiation and platelet formation certainly plays an important role, but the mechanisms of these processes also remain poorly understood. Iron
deficiency leads not only to impaired erythrocyte maturation, but also affects platelets, which raises interest in the study of this issue. Aim:
to review and summarize scientific data focused on the impact of absolute iron deficiency on megakaryopoiesis, as well as on quantitative,
morphological, and functional platelets characteristics in patients with iron deficiency anemia (IDA). Materials and Methods. A search for
scientific literature was conducted in PubMed/MEDLINE, Google Scholar, eLibrary, and CyberLeninka databases. The search query included
key terms in Russian and English: “absolute iron deficiency”, “iron deficiency anemia”, “thrombocytosis”, “thrombocytopenia”, “reactive thrombocytosis”, “megakaryopoiesis”, “platelets”. The strategy included the search for full-text publications in Russian and English, with reviews,
experimental works, clinical studies (retro- and prospective), and observational studies (including case reports) analyzed. This review utilized
44 scientific articles published in the last 10 years. Results. IDA is often accompanied by an increase in the number and size of platelets, with
exact mechanisms of this phenomenon being not fully understood to date. Thrombocytosis caused by iron deficiency is resolved by replenishment of iron stores. In experiments on rats with modeled iron deficiency, an increase in the number of megakaryocytes and increased angiogenesis in the bone marrow were observed. There are no unambiguous data on platelets functional activity under conditions of iron
deficiency, but a higher risk of thrombotic and thromboembolic events is registered, the mechanisms of which include thrombocytosis,
impaired laminar blood flow, and increased P-selectin expression. IDA is more rarely accompanied by thrombocytopenia. Conclusion. The
described changes in platelets may increase the risk of thrombotic events in patients with iron deficiency anemia. Further study of this issue
may help both in clinical practice and contribute to the development of new directions in fundamental medicine and biology.

For citation: Galak I.R., Fefelova E.V., Tsybikov N.N. Quantitative, morphological and functional platelet changes in iron deficiency anemia. Tromboz,
gemostaz i reologiya. 2025;(3):12–20. (In Russ.).

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