Refractory thrombocytopenia: A myelodysplastic syndrome that may mimic immune thrombocytopenic purpura

D. M. Menke, Gerardo Colon-Otero, K. J. Cockerill, Robert Brian Jenkins, P. Noel, R. V. Pierre

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

The French-American-British classification scheme of myelodysplastic syndromes includes a category of refractory cytopenia that includes refractory thrombocytopenia (RTC). Because dysmegakaryopoiesis manifesting as an isolated cytopenia can be difficult to identify morphologically and because it may be accompanied by megakaryocytic hyperplasia, RTC may be confused with idiopathic thrombocytopenic purpura. A review of 1,220 cases of myelodysplastic syndromes at Mayo Clinic Jacksonville and Mayo Clinic Rochester from 1979 to 1990 yielded 9 cases (0.7%) of isolated thrombocytopenia (RTC) associated with clonal chromosomes abnormalities. Review of 319 marrow chromosome analyses performed at the cytogenetics laboratory at Mayo Clinic Rochester from 1979 to 1990 for patients with low platelet count yielded two additional cases of RTC (0.6%). Of the 11 RTC cases, 3 previously had been misdiagnosed as idiopathic thrombocytopenic purpura. All patients had oval macrocytes in peripheral blood smears and abnormal megakaryocyte morphology in bone marrow aspirates, lacked antiplatelet antibodies, and did not have splenomegaly on clinical examination. The most common clonal chromosome abnormalities involved chromosomes 3, 5, 8, or 20. Steroid therapy was ineffective. Clinical and laboratory findings can establish the diagnosis of RTC and allow the physician to avoid recommending inappropriate therapy (steroids or splenectomy) for these patients.

Original languageEnglish (US)
Pages (from-to)502-510
Number of pages9
JournalAmerican Journal of Clinical Pathology
Volume98
Issue number5
StatePublished - 1992

Fingerprint

Idiopathic Thrombocytopenic Purpura
Myelodysplastic Syndromes
Thrombocytopenia
Chromosome Aberrations
Bone Marrow
Steroids
Chromosomes, Human, Pair 5
Chromosomes, Human, Pair 3
Megakaryocytes
Splenomegaly
Splenectomy
Diagnostic Errors
Platelet Count
Cytogenetics
Hyperplasia
Chromosomes
Physicians
Antibodies
Therapeutics

Keywords

  • Idiopathic thrombocytopenic purpura
  • Isolated thrombocytopenia
  • Myclodysplastic syndrome
  • Refractory thrombocytopenia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Refractory thrombocytopenia : A myelodysplastic syndrome that may mimic immune thrombocytopenic purpura. / Menke, D. M.; Colon-Otero, Gerardo; Cockerill, K. J.; Jenkins, Robert Brian; Noel, P.; Pierre, R. V.

In: American Journal of Clinical Pathology, Vol. 98, No. 5, 1992, p. 502-510.

Research output: Contribution to journalArticle

@article{bd027248e78841d1ba6496cc1da44cda,
title = "Refractory thrombocytopenia: A myelodysplastic syndrome that may mimic immune thrombocytopenic purpura",
abstract = "The French-American-British classification scheme of myelodysplastic syndromes includes a category of refractory cytopenia that includes refractory thrombocytopenia (RTC). Because dysmegakaryopoiesis manifesting as an isolated cytopenia can be difficult to identify morphologically and because it may be accompanied by megakaryocytic hyperplasia, RTC may be confused with idiopathic thrombocytopenic purpura. A review of 1,220 cases of myelodysplastic syndromes at Mayo Clinic Jacksonville and Mayo Clinic Rochester from 1979 to 1990 yielded 9 cases (0.7{\%}) of isolated thrombocytopenia (RTC) associated with clonal chromosomes abnormalities. Review of 319 marrow chromosome analyses performed at the cytogenetics laboratory at Mayo Clinic Rochester from 1979 to 1990 for patients with low platelet count yielded two additional cases of RTC (0.6{\%}). Of the 11 RTC cases, 3 previously had been misdiagnosed as idiopathic thrombocytopenic purpura. All patients had oval macrocytes in peripheral blood smears and abnormal megakaryocyte morphology in bone marrow aspirates, lacked antiplatelet antibodies, and did not have splenomegaly on clinical examination. The most common clonal chromosome abnormalities involved chromosomes 3, 5, 8, or 20. Steroid therapy was ineffective. Clinical and laboratory findings can establish the diagnosis of RTC and allow the physician to avoid recommending inappropriate therapy (steroids or splenectomy) for these patients.",
keywords = "Idiopathic thrombocytopenic purpura, Isolated thrombocytopenia, Myclodysplastic syndrome, Refractory thrombocytopenia",
author = "Menke, {D. M.} and Gerardo Colon-Otero and Cockerill, {K. J.} and Jenkins, {Robert Brian} and P. Noel and Pierre, {R. V.}",
year = "1992",
language = "English (US)",
volume = "98",
pages = "502--510",
journal = "American Journal of Clinical Pathology",
issn = "0002-9173",
publisher = "American Society of Clinical Pathologists",
number = "5",

}

TY - JOUR

T1 - Refractory thrombocytopenia

T2 - A myelodysplastic syndrome that may mimic immune thrombocytopenic purpura

AU - Menke, D. M.

AU - Colon-Otero, Gerardo

AU - Cockerill, K. J.

AU - Jenkins, Robert Brian

AU - Noel, P.

AU - Pierre, R. V.

PY - 1992

Y1 - 1992

N2 - The French-American-British classification scheme of myelodysplastic syndromes includes a category of refractory cytopenia that includes refractory thrombocytopenia (RTC). Because dysmegakaryopoiesis manifesting as an isolated cytopenia can be difficult to identify morphologically and because it may be accompanied by megakaryocytic hyperplasia, RTC may be confused with idiopathic thrombocytopenic purpura. A review of 1,220 cases of myelodysplastic syndromes at Mayo Clinic Jacksonville and Mayo Clinic Rochester from 1979 to 1990 yielded 9 cases (0.7%) of isolated thrombocytopenia (RTC) associated with clonal chromosomes abnormalities. Review of 319 marrow chromosome analyses performed at the cytogenetics laboratory at Mayo Clinic Rochester from 1979 to 1990 for patients with low platelet count yielded two additional cases of RTC (0.6%). Of the 11 RTC cases, 3 previously had been misdiagnosed as idiopathic thrombocytopenic purpura. All patients had oval macrocytes in peripheral blood smears and abnormal megakaryocyte morphology in bone marrow aspirates, lacked antiplatelet antibodies, and did not have splenomegaly on clinical examination. The most common clonal chromosome abnormalities involved chromosomes 3, 5, 8, or 20. Steroid therapy was ineffective. Clinical and laboratory findings can establish the diagnosis of RTC and allow the physician to avoid recommending inappropriate therapy (steroids or splenectomy) for these patients.

AB - The French-American-British classification scheme of myelodysplastic syndromes includes a category of refractory cytopenia that includes refractory thrombocytopenia (RTC). Because dysmegakaryopoiesis manifesting as an isolated cytopenia can be difficult to identify morphologically and because it may be accompanied by megakaryocytic hyperplasia, RTC may be confused with idiopathic thrombocytopenic purpura. A review of 1,220 cases of myelodysplastic syndromes at Mayo Clinic Jacksonville and Mayo Clinic Rochester from 1979 to 1990 yielded 9 cases (0.7%) of isolated thrombocytopenia (RTC) associated with clonal chromosomes abnormalities. Review of 319 marrow chromosome analyses performed at the cytogenetics laboratory at Mayo Clinic Rochester from 1979 to 1990 for patients with low platelet count yielded two additional cases of RTC (0.6%). Of the 11 RTC cases, 3 previously had been misdiagnosed as idiopathic thrombocytopenic purpura. All patients had oval macrocytes in peripheral blood smears and abnormal megakaryocyte morphology in bone marrow aspirates, lacked antiplatelet antibodies, and did not have splenomegaly on clinical examination. The most common clonal chromosome abnormalities involved chromosomes 3, 5, 8, or 20. Steroid therapy was ineffective. Clinical and laboratory findings can establish the diagnosis of RTC and allow the physician to avoid recommending inappropriate therapy (steroids or splenectomy) for these patients.

KW - Idiopathic thrombocytopenic purpura

KW - Isolated thrombocytopenia

KW - Myclodysplastic syndrome

KW - Refractory thrombocytopenia

UR - http://www.scopus.com/inward/record.url?scp=0026475228&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026475228&partnerID=8YFLogxK

M3 - Article

C2 - 1485603

AN - SCOPUS:0026475228

VL - 98

SP - 502

EP - 510

JO - American Journal of Clinical Pathology

JF - American Journal of Clinical Pathology

SN - 0002-9173

IS - 5

ER -