Isolated ulnar artery occlusion with concurrent internal jugular vein thrombosis in severe iron-deficiency anaemia

Introduction: Severe iron deficiency anaemia (IDA) is increasingly recognized as a cause of a reversible hypercoagulable state, although simultaneous arterial and venous thrombosis are rare. Several mechanisms have been proposed, including reactive thrombocytosis, endothelial dysfunction, and changes in erythrocyte rheology, which may be secondary to reduced tissue oxygenation. Case description: We report the case of a 41-year-old woman with chronic menorrhagia due to fibroids who developed digital cyanosis and neurologic deficits due to severe microcytic anaemia (Hb 6.7 g/dl), associated with severe iron deficiency and mild thrombocytosis (442 ×109/l). She was discharged after blood transfusion with therapy for Raynaud phenomenon (amlodipine) but returned to the emergency room due to an acute right ulnar artery occlusion complicated by internal jugular vein thrombosis that was managed with embolectomy and anticoagulation. Her digital function fully recovered, and she remained free of thrombophilia. Conclusion: Our case highlights the potential for severe IDA to cause both arterial and venous thrombosis, even in the setting of only modest platelet elevations. Chronic tobacco use may have contributed to her presentation, and clinicians should remain aware of the possibility of thrombosis in patients presenting with severe IDA who do not have other known pro-thrombotic conditions.