Severe Iron Deficiency Anemia Leading to Thrombocytosis With Arterial and Venous Thrombosis

A 45-year-old female who was a teacher by profession with a history of chronic asymptomatic anemia in the past presented to our hospital with complaints of intermittent fever for two weeks, cough with expectoration, dyspnea on exertion, and left upper limb edema for four days. She had a history of abdominal pain after food intake. She gave a history of having anemia for the past 23 years. Evaluation after admission showed raised inflammatory markers, marked thrombocytosis, and severe iron deficiency anemia. Further imaging in the form of a CT of the abdomen and thorax showed that she had a left-sided pleural effusion which showed an exudative picture, splenomegaly with a splenic infarct with a splenic abscess, and a suprarenal abdominal aorta thrombus. She was also found to have deep vein thrombosis (DVT) of the left subclavian and proximal internal jugular vein in a ultrasonogram (USG) Doppler. The workup done ruled out congenital and acquired causes of thrombosis and after extensive evaluation the patient was found to have unexplained thrombosis. The cause of unexplained thrombosis is the point of interest in this patient. Despite extensive workup, no precise cause for thrombosis, which was both arterial and venous in nature could be found out initially. Hence by exclusion, the possibility of secondary thrombocytosis causing the thrombosis was considered. Over the next few years, this patient underwent repeat esophageal endoscopies, colonoscopies, and capsule studies all without being able to pinpoint a diagnosis. Eventually three years later, a CT enteroscopy with biopsy showed the diagnosis of Crohn’s disease and the patient was started on appropriate immunosuppressive treatment for the same. There have been multiple case reports of thrombocytosis causing arterial or venous thrombus but not many have recorded both arterial and venous thrombosis in the same patient.