New Onset Severe Anemia and Fulminant Idiopathic Intracranial Hypertension

Anemia and idiopathic intracranial hypertension: a prospective study

BACKGROUND

Anemia has been temporally associated with idiopathic intracranial hypertension (IIH), but the relationship is uncertain because of a lack of prospective studies and because both IIH and anemia are common in young women with obesity.

DESIGN AND METHODS

This was a prospective study of consecutive patients with IIH referred to 3 neuro-ophthalmology centres between March 2021 and September 2022. All patients had a complete blood count available within 6 months of presentation. Anemia was defined as mild (110-120 g/L), moderate (80-109 g/L), and severe (<80 g/L).

RESULTS

Of 143 patients, 113 had normal hemoglobin (group 1) and 30 had anemia (group 2). In group 2, the anemia was defined as mild (15 of 30; 50.0%), moderate (11 of 30; 36.7%), and severe (4 of 30; 13.3%). There was no difference in female sex (105 of 113 vs 29 of 30; p = 0.453), age (31.5 ± 9.2 years vs 28.5 ± 10.3 years; p = 0.144), and body mass index (35.2 ± 6.9 kg/m2 vs 38.0 ± 8.1 kg/m2; p = 0.111). Groups 1 and 2 did not differ in visual acuity (0.04 ± 0.09 logMAR vs 0.07 ± 0.14 logMAR; p = 0.377), retinal nerve fibre layer thickness (174.5 ± 68.4 μm vs 206.5 ± 97.0 μm; p = 0.098), mean deviation (-3.2 ± 3.1 dB vs -3.9 ± 3.4 dB; p = 0.180), and the need for medical (34 of 113 vs 8 of 30; p = 0.715) or surgical treatment (3 of 113 vs 3 of 30; p = 0.074). Patients with moderate to severe anemia were more likely to require surgical therapy (2 of 15 vs 3 of 113; p = 0.045).

CONCLUSION

Approximately 1 of every 5 patients with IIH has anemia, and this is severe in >10% of patients. Patients with moderate and severe anemia may require more invasive surgical treatment. Given the high incidence of anemia and the availability of a complete blood count, we recommend that this test be obtained for all patients with suspected IIH.

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Anemia and Idiopathic Intracranial Hypertension: A Case-Control Study

BACKGROUND

Idiopathic intracranial hypertension (IIH) is a condition that mostly affects obese women of childbearing age but has been reported to be temporally related to new diagnoses of anemia. Despite these reports, the association between anemia and IIH remains controversial. The present study aimed to understand the strength of association between anemia and IIH through a case-control design.

METHODS

Consecutive IIH patients were recruited from neuro-ophthalmology clinics and matched by age and sex to consecutive patients attending neuro-ophthalmology clinics with diagnoses other than IIH. Complete blood counts (CBCs) were reviewed within 6 months of neuro-ophthalmology presentation, and anemia was diagnosed by hemoglobin of <120 g/L in women and <130 g/L in men. Anemia was classified as microcytic (mean corpuscular volume (MCV) < 80 fL), normocytic (MCV 80-100 fL), and macrocytic (MCV > 100 fL) as well as mild (hemoglobin >110 g/L), moderate (hemoglobin 80-109 g/L), and severe (hemoglobin <80 g/L).

RESULTS

One hundred twenty-three IIH patients and 113 controls were included in the study. More IIH patients than controls had anemia (22.8%, 28/123 vs 10.6%, 12/113, P = 0.01) with an odds ratio of 2.48 (95% CI: 1.19, 5.16). There were no differences in severity of anemia or MCV between IIH patients and controls, with anemia most often being mild (57.1%, 16/28 vs 75%, 9/12) and normocytic (50.0%, 14/28 vs 50.0%, 6/12). However, 17.9% (5/28) of IIH patients had severe anemia compared with zero in the control group. IIH patients had a higher mean platelet count than controls ( P < 0.001), and there were no differences on leukocyte counts.

CONCLUSION

Idiopathic intracranial hypertension patients have a higher prevalence of anemia compared with non-IIH neuro-ophthalmology patients. The anemia was mostly mild and may be explained by other factors related to worse health status and obesity, including low socioeconomic status, poor nutrition, and polycystic ovary syndrome. However, as a CBC is a widely available test and anemia may influence the IIH disease course, we propose that this test be obtained in all patients with new papilledema.