The Prevalence and Clinical Impact of Leukopenia Among Arab Population with Iron Deficiency Anemia an Experience from Qatar
Authors: Almasri Hussam A , Soliman Ashraf Tawfiq , Desanctis Vincenzo , Al-Tikrity Mustafa A , Alsaud Arwa E , Ahmad Rita Wafik , Babikir Mona M , Aldwairi Majd M , Kloub Mohammad N , Eisa Mahmoud S , Alhashimy Ruoa , Ahmed Shaima , Yassin Mohamed A 
Published: November 2020

Introduction
Severe IDA can cause many complications and impair the quality of life. Iron is an essential micronutrient required for catalysis, DNA synthesis, redox reactions and oxygen transport1. It is important for an early step in embryonic haematopoiesis, which is common for all developing blood cells. The link between IDA and leukopenia is not well recognized in the literature.
Objectives
To assess the prevalence and clinical significance of leukopenia in patients with IDA and effect of iron replacement and correction of anemia on the WBCs count.
Materials and Methods
We retrospectively reviewed the electronic medical records of all patients attended haematology clinic with the diagnosis of iron deficiency anemia (IDA) over 2 years in Hamad Medical Corporation, Qatar. All other causes of anemia and patients with systemic or chronic diseases were excluded.
Age, nationality, BMI, Complete blood count and iron parameters were collected before and after treatment with IV iron therapy. Associated infections at the time of presentation (IDA and leukopenia) were noted including the course of the infection and response to treatment. Leukopenia was defined as WBCs count below 4000/microlitre.
Statistical analysis was done using paired t test to compare variables after versus before iron therapy.
Results
Out of 1567 case of iron deficiency anemia, 80 case had leukopenia (5.105%)
Their mean Leukocytes count was 3.35 +/- 0.48 ×103 before iron replacement. 7 patients had infections; 4 had upper respiratory tract infection, 1 urinary tract infection, 1 gastroenteritis, 1 lymphadenitis. Six of them received antibiotics and they had no complications. After iron therapy and correction of anemia the leukocyte count increased significantly to 4.38 +/- 1.82×103 (P &lt; 0.05). There was no significant correlation between WBC count and iron parameters (Hb, TIBC, serum iron concentration).
Discussion
High level of erythropoietin in IDA is thought to cause down regulation of neutrophils in animal models. In our study leukopenia occurred in 5.1% of the big cohort with IDA. A previous study on 516 patients with IDA recorded leukopenia in 17.6% of them. Their cases with leukopenia occurred more in patients with severe anemia. The increase of WBC count with correction of anemia suggested a physiologic link between erythropoiesis and leukopoiesis.
However, our study did not show correlation between WBC count and Hb or any of the iron parameters. In concert with our finding, a study in healthy children (n = 556) did not find associations between the measured iron markers and WBC
In addition, the association between IDA and leukopenia did not significantly increase the risk of infections in our patients. The link between leukopenia and IDA needs to be addressed in more studies.
Conclusions:
The prevalence of leukopenia in this big cohort with IDA was 5.1%. This leukopenia was not associated with severe or complicated infections. There were no associations between the measured iron markers and white blood cell counts in healthy adults
Figure

Disclosures
No relevant conflicts of interest to declare.