Platelet counts and haemorrhagic diathesis in patients with myelodysplastic syndromes.
OBJECTIVE
Most patients with myelodysplastic syndromes (MDS) present with single or multiple lineage cytopenias in peripheral blood despite a hypercellular bone marrow. Thrombocytopenia, attributable to ineffective platelet production by dysfunctional megakaryocytes, has been estimated to occur in 40-65% of patients. However, there are hardly any studies on the clinical relevance of low platelet counts in MDS.


METHODS
We retrospectively analysed data from 2900 patients in the Duesseldorf MDS Registry who were diagnosed at our laboratory between 1982 and 2007.


RESULTS
At the time of diagnosis, 43% of the patients had a platelet count lower than 100 000/microL. Platelets were lower than 20 000/microL in 7% of the patients, especially in those with advanced stages of MDS, who showed a higher frequency of thrombocytopenia and platelet transfusion dependency. On multivariate analysis, platelet anisometry, hypocellularity of megakaryopoiesis, maturational defects of megakaryocytes and platelets <20 000/microL were independent variables showing a statistically significant correlation (P < 0.05) with clinical signs of bleeding. Platelets lower than 100 000/microL were associated with significantly shortened survival (P < 0.00005), because of an increased risk of progression to acute myeloid leukaemia (AML) (30% vs. 21%) (P < 0.02) and bleeding (16% vs. 8%) (P = 0.0005).


CONCLUSIONS
Thrombocytopenia is a strong predictor of short survival, with or without haemorrhagic complications.
Neukirchen
Judith
J
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University of Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany. Judith.Neukirchen@med.uni-duesseldorf.de
Blum
Sabine
S
Kuendgen
Andrea
A
Strupp
Corinna
C
Aivado
Manuel
M
Haas
Rainer
R
Aul
Carlo
C
Gattermann
Norbert
N
Germing
Ulrich
U
D018572:Disease-Free Survival; D005260:Female; D006474:Hemorrhagic Disorders / Q000097:blood* / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D009190:Myelodysplastic Syndromes / Q000097:blood* / Q000150:complications / Q000401:mortality* / Q000628:therapy; D010976:Platelet Count; D017713:Platelet Transfusion; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy