Skip to main content
SpringerLink
Log in

Anemia as a risk factor for cerebral venous thrombosis? An old hypothesis revisited

Results of a prospective study

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Several case reports have linked iron deficiency anemia with the occurrence of cerebral venous thrombosis (CVT) or stroke, yet, it is unclear whether this is a chance association.

Methods

In a case-control design data of whole blood count and screening for thrombophilic coagulation abnormalities of 121 prospectively identified patients with CVT and 120 healthy controls were compared. Anemia was defined as a hemoglobin (Hb) concentration of <120 g/l in females, and <130 g/l in males, severe anemia as a Hb <90 g/l. Adjusted odds ratios (OR) were calculated based on a logistic regression model treating variables with a level of significance of p ≤0.2 on univariate analysis as potential confounders.

Results

Thrombophilia (OR 1.22, 95% CI 1.07-1.76, p < 0.01), severe anemia (OR 1.10, 95% CI 1.01-2.22, p < 0.05), and hypercholesterinemia (OR 1.21, 95% CI 1.04-2.57, p < 0.05) were the only independent variables associated with CVT on multivariate analysis.

Conclusion

Severe anemia is significantly and independently associated with CVT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akins PT, Glenn S, Nemeth PM, Derdeyn CP (1996) Carotid artery thrombus associated with severe irondeficiency anemia and thrombocytosis. Stroke 27:1002–1005

    PubMed  CAS  Google Scholar 

  2. Aoki N, Sakai T (1989). Cerebral sinus thrombosis in patients with severe iron deficiency anaemia due to myoma uteri. Acta Neurochir (Wien) 97:131–134

    Article  CAS  Google Scholar 

  3. Ataga KI, Orringer EP (2003) Hypercoagulability in sickle cell disease: a curious paradoxon. Am J Med 115:721–728

    Article  PubMed  CAS  Google Scholar 

  4. Australian Institute of Health and Welfare Canberra (2005). Australia’s health 2004. The ninth biennial health report of the Australian Institute of Health and Welfare. AIHW Cat. No. AUS 44, (http://www.aihw.gov.au/publications/ aus/aha04/aha04-050222.pdf, accessed 04.04.2006)

  5. Belman AL, Roque CT, Ancona R, Anand AK, Davis RP (1990) Cerebral venous thrombosis in a child with iron deficiency anemia and thrombocytosis. Stroke 21:488–493

    PubMed  CAS  Google Scholar 

  6. Benedict SL, Bonkowsky JL, Thompson JA, van Orman CB, Boyer RS, Bale JF Jr., Filloux FM (2004) Cerebral sinovenous thrombosis in children: another reason to treat iron deficiency anemia. J Child Neurol 19:526–531

    Article  PubMed  Google Scholar 

  7. Bergmann RL, Gravens-Müller L, Hertwig K, Hinkel J, Andres B, Bergmann KE, Dudenhausen JW (2002) Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany. Eur J Obstet Gynecol Reprod Biol 102:155–160

    Article  PubMed  CAS  Google Scholar 

  8. Bundesärztekammer (2001). Richtlinien der Bundesärztekammer zur Qualitätssicherung quantitativer laboratoriumsmedizinischer Untersuchungen. Dtsch Ärztebl 98:A2747–A2759

    Google Scholar 

  9. Caliscan U, Oner AF, Kabakus N, Koc H (1999). Diminished platelet aggregation in patients with iron deficiency anemia. Clin Appl Thromb Hemost 5:161–163

    Article  Google Scholar 

  10. Centers for Disease Control, Prevention (2002) Iron deficiency — United States, 1999–2000. MMWR 51:897–899

    Google Scholar 

  11. Cheng CK, Chan J, Cembrowski GS, van Assendelft OW (2004) Complete blood count reference interval diagrams derived from NHANES III: stratification by age, sex, and race. Lab Hematol 10:42–53

    Article  PubMed  Google Scholar 

  12. Clark, A (1887) Observations on the anaemia or chlorosis of girls, occurring more commonly between the advent of menstruation and the consummation of womanhood. Lancet ii 1003–1005

  13. Deitcher SR (2003) Cancer and thrombosis: mechanisms and treatment. J Thromb Thrombolysis 16:21–31

    Article  PubMed  CAS  Google Scholar 

  14. Hart RG, Kanter MC (1990) Hematologic disorders and ischemic stroke. A selective review. Stroke 21:1111–1121

    PubMed  CAS  Google Scholar 

  15. Hartfield DS, Lowry NJ, Keene DL, Yager JY (1997). Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol 16:50–53

    Article  PubMed  CAS  Google Scholar 

  16. Iselin BM, Willimann PFX, Seifert B, Casutt M, Bombeli T, Zalunardo MP, Pasch T, Spahn DR (2001) Isolated reduction of haematocrit does not compromise in vitro blood coagulation. Br J Anaesth 87:246–249

    Article  PubMed  CAS  Google Scholar 

  17. Keung YK, Owen J (2004) Iron deficiency and thrombosis: literature review. Clin Appl Thromb Hemost 10:387–391

    Article  PubMed  CAS  Google Scholar 

  18. Kurekci AE, Atay AA, Sarici SU, Zeybek C, Koseoglu V, Ozcan O (2000) Effect of iron therapy on the whole blood platelet aggregation in infants with iron deficiency anemia. Thromb Res 97:281–285

    Article  PubMed  CAS  Google Scholar 

  19. Lammle B, Kremer Hovinga JA, Alberio L (2005) Thrombotic thrombocytopenic purpura. J Thromb Haemost 3:1663–1675

    Article  PubMed  CAS  Google Scholar 

  20. Leichtenstern O (1899) Ueber Venenthrombose bei Chlorose. Münchner Med Wochenschr 48:1603–1606

    Google Scholar 

  21. Ng KFJ, Lam CCK, Chan LC (2002) In vivo effect of haemodilution with saline on coagulation: a randomised controlled trial. Br J Anaesth 88:475–480

    Article  PubMed  CAS  Google Scholar 

  22. Osler W (1901) The principles and practice of medicine. 4th ed., Appelton and Co., New York, pp. 792–795

  23. Parker C, Omine M, Richards S, Nishimura J, Bessler M, Ware R, Hillmen P, Luzzatto L, Young N, Kinoshita T, Rosse W, Socié G, for the International PNH Interest Group (2005) Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood 106:3699–3709

    Article  PubMed  CAS  Google Scholar 

  24. Shiu YT, McIntire LV (2003). In vitro studies of erythrocytes - vascular endothelium interactions. Ann Biomed Eng 31:1299–1313

    Article  PubMed  Google Scholar 

  25. Spivak JL, Barosi G, Barosi G, Barbui T, Finazzi T, Marchioli R, Marchetti M (2003) Chronic myeloproliferative disorders. Hematology 200–224

  26. Stehle G Buss J, Heene DL (1991) Noninfectious thrombosis of the superior sagittal sinus in a patient with iron deficiency anemia. Stroke 22:414

    PubMed  CAS  Google Scholar 

  27. Vaitl J (1895) Zur Aetiologie und Pathogenese der autochthonen Sinusthrombose. Thesis University of Munich

  28. Von Dusch T (1861) On thrombosis of the cerebral sinuses. The New Sydenham Society, London

  29. Weill-Engerer S, Meaume S, Lahlou A, Piette F, Saint-Jean O, Sachet A, Beinis JY, Gallinari C, Grancher AS, Vincent JP, Naga H, Belmin J, Salvatore R, Kazes M, Pautas E, Boiffin A, Piera JB, Duviquet M, Knafo D, Piau A, Miric D, Jean A, Bellamy V, Tissandier O, Le Blanche AF (2004) Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. J Am Geriatr Soc 52:1299–1304

    Article  PubMed  Google Scholar 

  30. World Health Organization, United Nations Children’s Fund, United Nations University (2001) Iron deficiency anaemia: assessment, prevention, and control. Geneva, World Health Organization, (WHO/NHD/01.3), (http:// www.who.int/nut/documents/ ida_assessment_prevention_ control.pdf, accessed 08.11.2005)

  31. Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology, Justus-Liebig-University, Am Steg 14, 35385, Giessen, Germany

    Erwin Stolz MD, PhD, Franz Blaes MD, Tibo Gerriets MD & Manfred Kaps MD, PhD

  2. Neurological Center, Segeberger Kliniken, Hamdorfer Weg 3, 23795, Bad Segeberg, Germany

    José Manuel Valdueza MD, PhD

  3. Dept. of Internal Medicine, Division of Cardiology, Justus-Liebig-University, Klinikstrasse 36, 35385, Giessen, Germany

    Mathias Grebe MD

  4. Dept. of Neurology, University of Regensburg, Universitaetsstrasse 84, 93053, Regensburg, Germany

    Felix Schlachetzki MD

  5. Dept. of Neurology, Katholisches Klinikum, Haus St. Josef, Kardinal-Krementz-Str. 1-5, 56073, Koblenz, Germany

    Eberhard Schmitt MD & Anousha Rahimi MD

  6. Dept. of Hemostaseology and Transfusion Medicine, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

    Katharina Madlener MD

  7. Dept. of Internal Medicine, Division of Hemostaseology, Justus-Liebig-University, Klinikstrasse 36, 35385, Giessen, Germany

    Bettina Kempkes-Matthes MD

Authors
  1. Erwin Stolz MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Manuel Valdueza MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathias Grebe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felix Schlachetzki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eberhard Schmitt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katharina Madlener MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anousha Rahimi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bettina Kempkes-Matthes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Franz Blaes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tibo Gerriets MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Manfred Kaps MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erwin Stolz MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stolz, E., Valdueza, J.M., Grebe, M. et al. Anemia as a risk factor for cerebral venous thrombosis? An old hypothesis revisited. J Neurol 254, 729–734 (2007). https://doi.org/10.1007/s00415-006-0411-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0411-9

Key words

Search

Navigation