Stem cell steal after intravenous iron: a case of transient thrombocytopenia in severe iron deficiency anaemia

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Background: Iron-deficiency anaemia (IDA) commonly presents with reactive thrombocytosis. A less recognized, paradoxical decline in platelets may occur shortly after iron repletion. This phenomenon is most notably seen with intravenous (IV) formulations and termed the platelet steal effect. Case report: /μl by hospital day 5 without bleeding. Other causes of thrombocytopenia were systematically excluded. Iron therapy was continued and transitioned to oral supplementation; platelets stabilized by day 10 and recovered thereafter in parallel with haemoglobin improvement. Conclusion: Transient thrombocytopenia following iron repletion is likely under-recognized. Awareness of its timing and benign course may prevent unnecessary testing or interruption of definitive IDA therapy. LEARNING POINTS: Transient thrombocytopenia may occur shortly after intravenous iron repletion in severe iron deficiency anaemia, despite the usual association with thrombocytosis.The "stem cell steal" phenomenon reflects a temporary shift of bone marrow progenitors toward erythropoiesis once iron becomes available.Recognizing this benign, self-limiting response prevents unnecessary investigations or interruption of essential iron therapy.

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