Excessive naked megakaryocyte nuclei in myelodysplastic syndrome mimicking idiopathic thrombocytopenic purpura: a complicated pre- and post-transplantation course.
A boy 3 years 7 months old with thrombocytopenia and history of intracranial hemorrhage who underwent bone marrow transplantation is presented. He was refractory to steroids, immunoglobulin G, vincristine, azathioprine, cyclosporine A, interleukin-11, chemotherapy, and splenectomy. Idiopathic thrombocytopenic purpura was excluded by light /electron microscopic and flow cytometric findings; the diagnosis of refractory cytopenia, a subgroup of pediatric myelodysplastic syndrome, was made. Naked megakaryocyte nuclei were 55.38 +/- 28.2% vs. 31.67 +/- 23.22% of all megakaryocytes in the patient and the control group of 9 patients with idiopathic thrombocytopenic purpura, respectively (p = .016). The posttransplatation course was complicated by delayed platelet engraftment, bronchiolitis obliterans associated with pneumocystis carinii pneumonia, which resolved completely.
Olcay
Lale
L
Dr A.Y. Ankara Oncology Research and Education Hospital, Unit of Pediatric Hematology, Demetevler, Ankara, Turkey. laleolcay@hotmail.com.tr
Tuncer
A Murat
AM
Okur
Hamza
H
Erdemli
Esra
E
Uysal
Zumrut
Z
Cetin
Mualla
M
Duru
Feride
F
Cetinkaya
Duygu Uckan
DU
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016022:Case-Control Studies; D002467:Cell Nucleus / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007223:Infant; D008297:Male; D008533:Megakaryocytes / Q000473:pathology*; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000628:therapy; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000628:therapy