Iron deficiency anemia as a risk factor associated with stroke and cerebral venous thrombosis in children and adults - a systematic review

OBJECTIVES: Iron deficiency anemia (IDA) might have an association with stroke and cerebral venous thrombosis (CVT), but no systematic evaluation of the literature has been conducted to support this. The aim of this systematic review was to assess IDA as a potential risk factor for stroke and CVT by analyzing all papers published on IDA-related strokes and CVTs.

METHODS AND MATERIALS: A systematic review by use of the databases EMBASE and Pubmed. The study was registered at PROSPERO before data collection and PRISMA guidelines were followed. Case reports and studies on IDA as a risk factor for stroke and CVT were included with no limitations, though papers not written in English were excluded.

RESULTS: In total, 2202 papers were identified of which 87 were included, hereof 71 case reports or -series, 16 observational studies, and two papers comprising both categories. The 18 observational studies indicated an association of IDA with stroke, however, were limited by sample size. The case reports included 52 adult and 53 pediatric cases. Females accounted for 65.7 % of all reported cases. The median age of all included cases was 17.0 years (range 0.4-70.0). Mean hemoglobin was 6.7 g/dL (SD 2.3), and mean ferritin was 7 ng/mL (SD 6).

CONCLUSION: IDA is an under-investigated potential risk factor for stroke and CVT-especially in children and younger adults. Large-scale, longitudinal studies are needed to confirm IDA as a stroke and CVT risk factor and identify specific subgroups at a higher risk of stroke and CVT associated with IDA.