A Tangled Web of Blood and Clots – A Retrospective Prevalence Study of Anemia in CVT

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon but potentially life-threatening condition, often affecting young adults. Emerging evidence suggests anemia as a possible risk factor for CVT, but robust clinical data remains limited(1,2). This study aims to investigate the prevalence of anemia in CVT patients and evaluate its association with clinical presentation, risk factors, and outcomes. OBJECTIVES: Primary Objective – To determine the prevalence of anaemia in patients with CVT. Secondary Objective – To assess the association between anaemia and other demographics in CVT. MATERIALS AND METHODS: We conducted a retrospective case analysis involving 69 patients diagnosed with cerebral venous thrombosis (CVT) at Bangalore Baptist Hospital between January 2021 and November 2024. Comprehensive data were collected on demographics, clinical presentation, risk factors, and imaging findings. Laboratory parameters, including hemoglobin levels and mean corpuscular volume (MCV), were analyzed to assess the prevalence and classify anemia into microcytic, normocytic, and macrocytic subtypes(5). Statistical analysis was undertaken to compare anemic and non-anemic groups, to explore the relationship between anemia subtypes and severity and assess CVT related complications RESULTS: Total of 69 patients with CVT were included in the study. The mean age was 40 +/- 14 years. Anaemia was seen in 47.1% of patients and gender showed significant association with anemia (p < 0.001) with female:male ratio being 60:40. Microcytic anemia was the most common type (41.4%), suggesting iron deficiency as a potential contributor. Severe anemia was observed in 22.9% of patients, followed by moderate anemia in 20%. Among the presenting complaints, headache was the most frequent symptom (72.9%), followed by seizures (48.6%), papilledema (47.1%), and focal neurological deficits (27.1%). There was no distinct change in symptomatology between anaemia and non anaemia groups. CONCLUSIONS: This study highlights the significant prevalence of anemia in CVT patients, with nearly half of the cohort affected (47.1%), higher than what has been reported before. For instance, the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)(3) documented anemia in only 9.2% of patients, In contrast, an Indian registry that systematically measured hemoglobin and applied similar anemia criteria reported a prevalence of 18.4%(3). A more recent case control study showed prevalence of anemia in only 27% of CVT patients(1). The predominance of microcytic anemia suggests a potential role for iron deficiency in CVT pathogenesis, possibly through mechanisms such as endothelial dysfunction and thrombocytosis(4). The disproportionate burden of anemia among females reflects gender-specific risk factors, such as pregnancy and oral contraceptive use. These findings reinforce the need for routine screening and management of anemia to optimize outcomes in CVT patients, but further investigation is warranted to confirm causality.