Chronic myeloid leukaemia with extreme thrombocytosis

Abstract

We report two cases of chronic myeloid leukaemia (CML) with extreme thrombocytosis. The first patient was a 65-year-old man who presented with prolonged history of upper abdominal discomfort, anorexia and two episodes of recent gum bleeds without fever or other bleeding manifestations. He was a chronic smoker with no other comorbidities. Examination revealed moderate hepatosplenomegaly. On investigation, he was found to have extreme thrombocytosis (3 500 000/mm3) and leucocytosis with moderate anaemia. In view of the leucocytosis, he was investigated for CML and found to be positive for BCR-ABL by reverse transcription PCR (RT-PCR). He received imatinib 400 mg/day and achieved complete haematological response at the end of 3 months. The second patient was a 7-year-old boy who presented with fever, cough and cold of 2-week duration. Examination revealed mild hepatomegaly with palpable spleen tip. Haemogram and peripheral smear revealed moderate leucocytosis with extreme thrombocytosis (2 800 000/mm3). On evaluation, he was found to be BCR-ABL positive and responded well to imatinib treatment. In both these cases, massive thrombocytosis was an unusual presentation of a well-known entity, namely, CML. This degree of thrombocytosis is usually seen only in essential thrombocytosis.

Bleeding signs due to acquired von Willebrand syndrome at diagnosis of chronic myeloid leukaemia in children

“…At diagnosis, 9 out of these 87 (10·3%) patients had haemorrhagic or thrombotic complications, with severe grade in three individuals only. Thus, thrombocytosis may occasionally add to the array of clinical manifestations and increase morbidity as well as mortality of CML in adults (Rice & Popat, ; Verma et al , ; Jain, ).…”

“…There are some reports on single cases, but no article has systematically investigated AVWS in paediatric patients with CML at diagnosis presenting with thrombocytosis (McCarthy et al , ; Byun et al , ; Verma et al , ; Huho et al , ). Therefore, in order to fully understand the clinical characteristics and potential haemostaselogical problems, we retrospectively reviewed and analysed the clinical information on paediatric patients with CML and associated thrombocytosis enrolled into a large paediatric phase 3 trial on upfront treatment with the tyrosine kinase inhibitor (TKI) imatinib (Suttorp et al , ).…”

Pediatric Chronic Myeloid Leukemia Presenting With Extreme Thrombocytosis and Acute Upper Gastrointestinal Hemorrhage: A Case Report

“…6 Including the case mentioned above, only 6 children with CML presenting with isolated extreme thrombocytosis have been reported (Table 1). [7][8][9][10][11]…”

“…Including the case mentioned above, only 6 children with CML presenting with isolated extreme thrombocytosis have been reported (Table 1). 7–11 These cases emphasize the need to detect BCR-ABL transcripts and the Philadelphia chromosome when patients present with thrombocytosis, without an elevated WBC count and splenomegaly, or with atypical BM results.…”