Causes of Thrombocytopenia in Patients above 50 Years and Distinguishing Chronic Idiopathic Thrombocytopenic Purpura from Refractory Thrombocytopenia of Myelodysplastic Syndrome
Authors/Creators
- 1. Assistant Professor, Department of Pathology, KMCT Medical College, Manassery, Kerala, India
- 2. Professor, Department of Pathology, Kozhikode Medical College, Kerala, India
- 3. Professor & HOD, Department of Pathology, KMCT Medical College, Manassery, Kerala, India
Description
Background and Objectives: Thrombocytopenia is a problem commonly encountered in the elderly with a variety of etiology. Causes of thrombocytopenia is not well studied in the elderly. Both Chronic Idiopathic Thrombocytopenic purpura and Myelodysplastic syndrome are two hematological conditions that can present as chronic persistent thrombocytopenia. Both these entities have different prognosis, predictive survival and treatment. The objective of this study was to find the causes of thrombocytopenia in patients above 50 years and to distinguish Chronic Idiopathic Thrombocytopenic purpura from Refractory thrombocytopenia of Myelodysplastic syndrome in patients coming to Department of Clinical Pathology, Govt. Medical College Kozhikode during the study period. Materials and Methods: In this descriptive observational prospective study, a total of 150 cases of thrombocytopenia coming to clinical pathology department were selected by simple random sampling. Study group was patients above 50 years. Study period is from January 2017 to September 2018. Morphological study of peripheral smear, Bone marrow aspirate, imprint, and trephine biopsy was done in these patients. Special stains PAS and Perls were done, on marrow aspirate IHC for CD34 on bone marrow Trephine to look for increase in blasts in Myelodysplastic syndrome. Results: The most common cause of thrombocytopenia in this study was infections 35(23%) followed by Chronic persistent thrombocytopenia, Acute Leukemia and Megaloblastic Anemia. The commonest infections were Dengue fever, Leptospirosis, Sepsis, etc. On follow up there were 28 cases of Chronic Persistent Thrombocytopenia. Out of these there were 20 cases of Chronic ITP where thrombocytopenia persisted and 8 cases which can be either Chronic ITP or MDS. Micromegakaryocytes was observed in 13 cases (65%) of Chronic ITP compared to Chronic ITP/MDS (p value 0.06). Megakaryocyte proliferation was observed in 10 (50%) cases of Chronic ITP compared to cases of Chronic ITP/MDS. Conclusion and Limitation: From this study it was found that the most common cause of thrombocytopenia above 50 years was infections. Both ITP and MDS can cause morphological alterations in the megakaryocytes. In true cases of ITP, majority of megakaryocytes are micro or hypolobated forms, whereas in MDS, majority are normally lobated and hypolobated forms. A better distinction is possible only with a long follow up and cytogenetic study.
Abstract (English)
Background and Objectives: Thrombocytopenia is a problem commonly encountered in the elderly with a variety of etiology. Causes of thrombocytopenia is not well studied in the elderly. Both Chronic Idiopathic Thrombocytopenic purpura and Myelodysplastic syndrome are two hematological conditions that can present as chronic persistent thrombocytopenia. Both these entities have different prognosis, predictive survival and treatment. The objective of this study was to find the causes of thrombocytopenia in patients above 50 years and to distinguish Chronic Idiopathic Thrombocytopenic purpura from Refractory thrombocytopenia of Myelodysplastic syndrome in patients coming to Department of Clinical Pathology, Govt. Medical College Kozhikode during the study period. Materials and Methods: In this descriptive observational prospective study, a total of 150 cases of thrombocytopenia coming to clinical pathology department were selected by simple random sampling. Study group was patients above 50 years. Study period is from January 2017 to September 2018. Morphological study of peripheral smear, Bone marrow aspirate, imprint, and trephine biopsy was done in these patients. Special stains PAS and Perls were done, on marrow aspirate IHC for CD34 on bone marrow Trephine to look for increase in blasts in Myelodysplastic syndrome. Results: The most common cause of thrombocytopenia in this study was infections 35(23%) followed by Chronic persistent thrombocytopenia, Acute Leukemia and Megaloblastic Anemia. The commonest infections were Dengue fever, Leptospirosis, Sepsis, etc. On follow up there were 28 cases of Chronic Persistent Thrombocytopenia. Out of these there were 20 cases of Chronic ITP where thrombocytopenia persisted and 8 cases which can be either Chronic ITP or MDS. Micromegakaryocytes was observed in 13 cases (65%) of Chronic ITP compared to Chronic ITP/MDS (p value 0.06). Megakaryocyte proliferation was observed in 10 (50%) cases of Chronic ITP compared to cases of Chronic ITP/MDS. Conclusion and Limitation: From this study it was found that the most common cause of thrombocytopenia above 50 years was infections. Both ITP and MDS can cause morphological alterations in the megakaryocytes. In true cases of ITP, majority of megakaryocytes are micro or hypolobated forms, whereas in MDS, majority are normally lobated and hypolobated forms. A better distinction is possible only with a long follow up and cytogenetic study.
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IJPCR,Vol16,Issue7,Article55.pdf
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Additional details
Dates
- Accepted
-
2024-06-25
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue7,Article55.pdf
- Development Status
- Active
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