scholarly journals Pathophysiology, Diagnosis and Treatment of Immune Thrombocytopenia

2017 ◽  
Vol 5 (1) ◽  
pp. 32-36
Author(s):  
Mihnea-Alexandru Găman ◽  
Amelia Maria Găman

Immune thrombocytopenia (ITP) is an acquired disorder characterized by isolated thrombocytopenia with a peripheral blood count < 100.000/ mm3 in the absence of any obvious initiating or underlying causes, by antibody mediated destruction of platelets and suppression of megakaryocyte and platelet production on the basis of immune deregulation. ITP is idiopathic (primary) in 80% of cases and secondary to several associated disorders in 20% of cases. A diagnosis of exclusion, based on patient history, physical examination, complete blood count and examination of the peripheral blood smear, is used for ITP. The treatment of ITP is indicated in adult patients with platelet counts below 20.000-30.000/ mm3, with bleedings or risk for bleeding. First line therapy is represented by corticosteroids, intravenous immunoglobulins and intravenous anti-RhD. Second-line treatment is represented by: splenectomy, inhibition of the monocytic phagocytic system therapy, immunosupressive therapy, anabolic steroids, anti-CD20 therapy, and thrombopoietin receptor agonists.

2018 ◽  
Vol 38 (6) ◽  
pp. 512-517
Author(s):  
Young-gon Kim ◽  
Jung Ah Kwon ◽  
Yeonsook Moon ◽  
Seong Jun Park ◽  
Sangwook Kim ◽  
...  

2019 ◽  
Vol 12 (10) ◽  
pp. e230958 ◽  
Author(s):  
Elva Nieto-Borrajo ◽  
Alfredo Bermejo-Rodriguez

A follow-up blood count was performed on a 74-year-old woman diagnosed with colitis due to cytomegalovirus and under treatment with valganciclovir. The automated complete blood count revealed an abnormal white blood cells (WBC) scattergram together with WBC alert flags. The peripheral blood smear showed neutrophils with markedly hyposegmented nuclei or bilobed nuclei and very condensed chromatin or clumping chromatin all consistent with Pelger-Huët anomaly (PHA). We checked previous blood counts, ruling out an inherited PHA. We assessed the haematological, infectious and iatrogenic aetiologies for an acquired PHA. Once the valganciclovir treatment was completed and the drug was withdrawn, without changing the rest of the treatment, the morphological abnormalities of neutrophils were completely resolved. We conclude therefore that the acquired PHA presented by our patient is probably related to valganciclovir treatment.


2019 ◽  
Vol 47 (8) ◽  
pp. 3757-3762
Author(s):  
Niculina Mang ◽  
Anda C. Vizitiu ◽  
Andrei Anghel

Objectives Down syndrome (DS) is associated with multiple complications, including a high risk of leukemia and thyroid dysfunction. This clinical study aimed to examine the complete blood cell count in patients with DS without leukemia or transient abnormal myelopoiesis. We also aimed to evaluate the effect of thyroid dysfunction on hematological anomalies in DS. Methods We analyzed the peripheral blood cell count in 23 pediatric patients with DS with and without thyroid dysfunction and in 17 pediatric patients without DS with thyroid dysfunction. Results Patients with DS showed greater neutrophilia and lymphopenia than did patients with DS and hypothyroidism and patients with hypothyroidism. Surprisingly, patients with DS showed a significant degree of eosinopenia in the peripheral blood. Interestingly, hypothyroidism had an attenuating effect on different lineages in the complete blood count. However, these anomalies were specific for DS. Conclusions Our clinical findings support previous data on DS-associated changes in the complete blood count. Our study also shows novel alterations in the complete blood count in leukemia-free patients with DS in association with hypothyroidism. The attenuating effect of thyroid dysfunction on changes in different lineages in the context of DS is novel and deserves further analysis in larger studies.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5356-5356 ◽  
Author(s):  
Rupin A Shah ◽  
Satyajit Mohite ◽  
Veerabhadran Baladandayuthapani ◽  
Sheeba K. Thomas ◽  
Donna M. Weber ◽  
...  

Abstract Introduction Plasma cell leukemia (PCL) is a plasma cell dyscrasia that predicts for a shortened survival. World Health Organization (WHO) criteria require the presence of ≥20% circulating plasma cells (CPC) in the peripheral blood, and an absolute plasma cell count ≥2,000/µl (microliter). These criteria for PCL were established by Noel and Kyle in 1974, but subsequent studies to further validate this cut off are lacking. Since the presence of any plasma cells in the peripheral blood is now known to be a poor-risk feature, we sought to compare the overall survival of patients (pts) with any CPC observed on routine complete blood count (CBC) and differential with those that meet the WHO criteria of PCL. Methods We evaluated pts that received hyper-CVAD (cyclophosphamide /vincristine/doxorubicin/dex); CBAD (cyclophosphamide/bortezomib/doxorubicin/ dex), and DT-PACE (dexamethasone/thalidomide/ cisplatin /etoposide / doxorubicin/ cyclophosphamide) chemotherapy at The University of Texas M. D. Anderson Cancer Center for multiple myeloma from 2003-2012. We included pts with circulating blasts, plasma cells, or plasmacytoid cells regardless of the percentage (%) and absolute count. Pts were excluded if blasts or plasma cells were seen transiently in the setting of leukopheresis, growth factor support, or during severe sepsis. Overall survival (OS) was defined from the first detection of CPC until death due to any cause. We treated the % of plasma cells in the CBC as a continuous variable in the range from 1% to 20%. Pts with plasma cells below the cut off were defined as the “low” group and their survival was compared to the pts with plasma cells above the cut off that was defined as the “high” group. We conducted a log rank test for difference in survival curves between the two groups for each cut off, and the results were verified with a Cox model and both results were identical. Results 85 pts were identified with presence of any CPC or PCL diagnosed based on WHO criteria; 19 had primary PCL (pPCL) and 66 pts had secondary PCL (sPCL). At the time of diagnosis, 83 (2 with unknown values) pts had a median CPC of 4% and median absolute plasma cells of 178/µL. 73 pts had cytogenetic abnormalities by florescence in situ hybridization studies, including deletion/monosomy 13 in 32 pts, IgH gene rearrangement in 24 pts and TP53 deletions in 12 pts. 17/19 pts with pPCL received bortezomib based therapy and 14/19 underwent stem cell transplant. 26 pts met the WHO criteria of PCL at some point during their disease, including 11 who met criteria when plasma cells were first detected, and 15 who had CPC < 20% initially, but subsequently met WHO criteria.  Of the remaining 57 pts that did not meet the WHO criteria for presence of both absolute plasma cell count and % plasma cells, 13 met one of the criteria during the course of their disease. 44 pts had CPC but did not meet either of the WHO criteria. Survival data were available for 79/85 pts. Pts with pPCL (either by CPC or met at least one of the WHO criteria) had a median OS of 18.5 months. pPCL pts who only had CPC and did not meet either of the WHO criteria (n=5) had a median OS of 19 months; pPCL patients who met either or both of the WHO criteria (n=13) had a median OS of 18 months.  Pts with sPCL (either by CPC or met at least one of the WHO criteria) had a median OS of 5 months (n=61). sPCL pts who only had CPC and did not meet either of the WHO criteria (n=39) had a median OS of 5 months; sPCL patients who met either or both of the WHO criteria (n=22) had a median OS of 4 months. Based on evaluating plasma cell %  as a dichotomous factor with cut-off ranging  from 1% to 20%, there was no significant difference in overall survival based on specific levels of plasma cell percent, and verified with a Cox model, however with many cut-offs, the sample size was small potentially limiting analysis. Conclusion In our analysis of OS of pts having plasma cells in their peripheral blood, we did not find any statistically significant difference based on their degree of % plasma cells or absolute plasma cells at the time of diagnosis. This supports the hypothesis that, irrespective of quantity, the presence of any plasma cells in the CBC is a poor prognostic indicator, with a similar natural history and a uniformly poor OS. While these findings will need to be validated in a larger, independent dataset, we would propose that these initial data support redefining the diagnostic criteria of PCL to include any pt with CPC observed in a routine CBC. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4619-4619
Author(s):  
Yan Zheng ◽  
Guangyuan Li ◽  
Menglei Zhu ◽  
Yu Li ◽  
Howard Meyerson ◽  
...  

Abstract Cellular prion protein (PrPC) is a GPI-anchored cell surface glycoprotein that is expressed in the brain, blood, bone marrow (BM), and lymphoid tissue. PrPC can be converted post-translationally into scrapie-PrP (PrPSc), which is involved in the pathogenesis of neurodegenerative diseases including Creutzfeldt-Jakob disease, Kuru disease in humans, and scrapie and bovine spongiform encephalopathy in animals. However, the biological function of PrPSc has yet to be conclusively elucidated. In order to understand the role of PrPC in the hematopoietic system, we compared bone marrow, lymphoid organs and peripheral blood of PrPC knockout mice (KO) to age and sex-matched transgenic mice used as background controls (WT) expressing human PrPC under the control of a mouse PrPC promoter with a slightly augmented expression (2-fold) of PrPC. Complete blood count (CBC) showed a significant increase of WBC in KO mice (KO 9.03 ± 5.16 x109/L vs. WT 4.13 ± 1.87 x109/L, p = 0.0405; Table 1 and Figure 1). Further analysis of WBC differential revealed that the elevated number of WBC in KO mice was due to lymphocytosis. Specifically, KO mice had a 3-fold increase in the absolute lymphocyte count (KO 7.59 ± 4.63 x109/L vs. WT 2.90 ± 1.32 x109/L, p = 0.0303), as well as a higher lymphocyte percentage (KO 82.47 ± 4.20% vs. WT 70.19 ± 4.44%, p = 0.0011) compared to controls. KO mice also had a trend toward higher hemoglobin (KO 12.00 ± 4.40 g/dL vs. WT 9.84 ± 4.83 g/dL), RBC (KO 8.01 ± 2.87 x1012/L vs. WT 6.25 ± 3.11 x1012/L), and hematocrit (KO 43.94 ± 17.00 % vs. WT 36.04 ± 18.07 %) compared to WT mice. Additionally, platelet count in KO mice was higher than control mice (KO 762.20 ± 138.61 x 109/L vs. WT 661.80 ± 230.20 x 109/L). Of interest, the mean platelet volume (platelet size) was significantly increased in KO mice compared to controls (KO 6.00 ± 0.29 fL vs. WT 5.24 ± 0.56 fL, p =0.0140). Thus, absence of PrPC resulted in significant leukocytosis and specifically higher absolute count and percentage of lymphocytes, as well as larger platelets in peripheral blood. To further analyze if the observed lymphocytosis is due to abnormalities in hematopoiesis or lymphopoiesis, bone marrow (BM), thymus, spleen and lymph nodes from WT and KO mice were isolated and examined by flow cytometry using a comprehensive panel of fluorochrome-conjugated antibodies specific for all hematologic cell precursors/lineages. Analysis of all cell populations in each of these organs revealed no significant differences in the numbers of RBC and megakaryocyte in BM, and of lymphocytes in the thymus, spleen and lymph nodes (data no shown). Additionally, histological analysis of BM, thymus, spleen and lymph nodes tissue from KO and WT animals failed to show morphological differences between the two groups (data not shown). Therefore, lack of PrPC does not appear to affect hematopoiesis and lymphopoiesis. In summary, our findings indicate that PrPC deficiency translates into a significant increase in the number of lymphocytes in peripheral blood; however, development and maturation of lymphocytes in KO mice appeared normal. Therefore, PrPC might be critical in the survival and trafficking of lymphocytes in peripheral blood. The molecular mechanisms underlying the observed changes in lymphocytes and platelets, and whether there are any related changes in the functions of lymphocytes and platelets will be subject of future studies. Table 1. Complete blood count (CBC) of PrPC WT and KO mice WT KO p value Mean ± SD Mean ± SD WBC (109/L) 4.13 ± 1.87 9.03 ± 5.16 0.0405 Absolute lymphocyte count (109/L) 2.90 ± 1.32 7.59 ± 4.63 0.0303 Lymphocyte (%) 70.19 ± 4.44 82.47 ± 4.20 0.0011 RBC (1012/L) 6.25 ± 3.11 8.01 ± 2.87 0.1898 HB (g/dL) 9.84 ± 4.83 12.00 ± 4.40 0.2404 HCT (%) 36.04 ± 18.07 43.94 ± 17.00 0.2618 PLT (109/L) 661.80 ± 230.20 762.20 ± 138.61 0.2138 MPV (fL) 5.24 ± 0.56 6.00 ± 0.29 0.0140 SD: Standard deviation; WBC: White blood cell; RBC: Red blood cell; HB: Hemoglobin; HCT: Hematocrit; RDW: Red cell distribution width; PLT: Platelet; MPV: Mean platelet volume Figure 1. PrPC deficiency results in lymphocytosis in peripheral blood. Figure 1. PrPC deficiency results in lymphocytosis in peripheral blood. Disclosures No relevant conflicts of interest to declare.


Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 283-285 ◽  
Author(s):  
Jenny M. Despotovic ◽  
Cindy E. Neunert

Abstract A 5-year-old boy presents with platelet count of 2 × 109/L and clinical and laboratory evidence of immune thrombocytopenia. He has epistaxis and oral mucosal bleeding. Complete blood count reveals isolated thrombocytopenia without any decline in hemoglobin and he is Rh+. You are asked if anti-D immunoglobulin is an appropriate initial therapy for this child given the 2010 Food and Drug Administration “black-box” warning.


2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Kanda Fanhchaksai ◽  
Suphara Manowong ◽  
Rungrote Natesirinilkul ◽  
Lalita Sathitsamitphong ◽  
Pimlak Charoenkwan

A term male newborn born to a mother who had hereditary spherocytosis presented with neonatal jaundice at 20 hours of life. Complete blood count showed hemoglobin 17.1 g/dL, MCV 104.2 fL, MCH 32.9 pg, and MCHC 31.6 g/dL. The patient had indirect hyperbilirubinemia requiring phototherapy. The maximum total bilirubin level was 12.15 mg/dL at 20 hours of life. Peripheral blood smear revealed spherocytes, crenated red cells, and polychromasia. A flow cytometric test with eosin-5-maleimide- (EMA-) labeled RBC was performed in the patient and parents. The fluorescence histograms of EMA-labeled RBC from the patient and mother were shifted to the left, and the fluorescence ratio when compared with normal was 0.69 and 0.84, respectively. The flow cytometric test with EMA is useful in supporting the diagnosis of hereditary spherocytosis during newborn period.


2020 ◽  
Vol 6 (4) ◽  
pp. 243-248
Author(s):  
Réka Toth ◽  
Alina Grama ◽  
Cristina Maki ◽  
Mihaela Ioana Chinceșan

AbstractIntroductionIn acute myeloblastic leukaemia (AML) explosive proliferation and accumulation of immature myeloid cell clones take place, replacing the bone marrow, with the possibility of the formation of extramedullary tumour masses composed of myeloid cells. The onset of the disease less frequently consists of symptoms of extramedullary manifestation.Case presentationA Caucasian male child aged three years and 11 months was hospitalized for bilateral exophthalmos and otorrhea, due to an alteration in his general condition. Ocular ultrasound revealed an inhomogeneous thickening of the upper right muscles superior to the eyeball. A complete blood count showed severe anaemia, leucocytosis with neutropenia and thrombocytopenia. A peripheral blood smear evidenced myeloblasts. The result of the cytology of bone marrow confirmed the diagnosis of AML. Following blood product replacements and cytostatic treatment (AML-BFM 2004 HR protocol), the remission of exophthalmos and the correction of haematological parameters were favourable.ConclusionIn a child with a sudden onset of exophthalmia and altered general condition, the diagnosis of acute leukaemia should be considered. The importance of performing a peripheral blood smear and bone marrow examination is emphasized so that diagnosis and initiation of treatment are not delayed.


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