Thrombocytopenia with Decreased Megakaryocytes

Abstract

The presenting clinical pictures and courses of seven patients with thrombocytopenia, decreased megakaryocytes in the marrow, and minimal changes in other hematopoietic cell lines are described. Little information exists in the literature on such patients. Initial bone marrow aspiration and biopsy in all patients showed decreased megakaryocytes with an otherwise normal marrow. Erythrocyte mean corpuscular volume was elevated in five of seven patients. Bone marrow karyotypes of six of the seven patients were normal. Chromium-51 platelet survival studies with platelet sizing, done in five of the seven patients, showed normal results. In two patients the course progressed to aplastic anemia. One of these died 9 months after presentation, and one responded dramatically to lithium. One patient developed preleukemia and died. The other four patients have remained thrombocytopenic but clinically stable. No useful therapy was identified. The differential diagnosis of such patients should include idiopathic thrombocytopenic purpura with misinterpretation of morphologic findings, hereditary and acquired aplastic anemia, preleukemia, and systemic lupus erythematosus.

Acquired amegakaryocytic thrombocytopenia purpura and eosinophilic fasciitis: A long relapsing and remitting course

“…AATP usually presents with bruising, bleeding, and absence of splenomegaly with platelet survival studies usually being normal [4]. Our patient had a typical occurrence of AATP as reported with severe thrombocytopenia ( <5,000/mL), preserved red and white blood cell lines, and absence of megakaryocytes on the bone marrow biopsy.…”

Purification and partial characterization of a megakaryocyte colony-stimulating factor from human plasma.

“…The marrow specimens were most notable for a total absence of megakaryocytic elements. This clinical picture was compatible with a diagnosis of selective hypomegakaryocytic thrombocytopenia (12). Because (15) was modified by the substitution of heat-inactivated human AB serum for fetal calf serum, and a-medium minus nucleosides for NCTC-109 medium and Eagle's minimal essential medium with Hanks' balanced salt solution.…”

Unusual Myelodysplastic Syndrome with the Initial Presentation Mimicking Idiopathic Thrombocytopenic Purpura

“…Although MDS with minimal dysplasia seemed to be similar to the conditions noted in our 5 confusing cases among a number of MDS subtypes with respect to slowly progressive cytopenia attributable to defective hematopoiesis, rare progression to leukemia, and a relatively favorable prognosis [1, 2, 3, 4, 12, 13, 14], we considered that this was not an appropriate diagnosis for our 5 confusing cases in the absence of prominent dyserythropoiesis [15]. We suggest that in confusing cases such as ours, a temporary, working diagnosis of so-called ‘not quite MDS’ or ‘not yet MDS’ with initial presentation of immune thrombocytopenia may be appropriate until further clinical developments help to establish a definitive diagnosis [2].…”