Chronic myeloid leukaemia with extreme thrombocytosis.
We report two cases of chronic myeloid leukaemia (CML) with extreme thrombocytosis. The first patient was a 65-year-old man who presented with prolonged history of upper abdominal discomfort, anorexia and two episodes of recent gum bleeds without fever or other bleeding manifestations. He was a chronic smoker with no other comorbidities. Examination revealed moderate hepatosplenomegaly. On investigation, he was found to have extreme thrombocytosis (3,500,000/mm(3)) and leucocytosis with moderate anaemia. In view of the leucocytosis, he was investigated for CML and found to be positive for BCR-ABL by reverse transcription PCR (RT-PCR). He received imatinib 400 mg/day and achieved complete haematological response at the end of 3 months. The second patient was a 7-year-old boy who presented with fever, cough and cold of 2-week duration. Examination revealed mild hepatomegaly with palpable spleen tip. Haemogram and peripheral smear revealed moderate leucocytosis with extreme thrombocytosis (2,800,000/mm(3)). On evaluation, he was found to be BCR-ABL positive and responded well to imatinib treatment. In both these cases, massive thrombocytosis was an unusual presentation of a well-known entity, namely, CML. This degree of thrombocytosis is usually seen only in essential thrombocytosis.
Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Shailendra Prasad
SP
Verma
Department of Medicine, JIPMER, Pondicherry, India.
Arunkumar
A
Subbiah
Department of Pathology, JIPMER, Pondicherry, India.
Sajini Elizabeth
SE
Jacob
Department of Pathology, JIPMER, Pondicherry, India.
Debdatta
D
Basu
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D016313:Genes, abl; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D008297:Male; D013922:Thrombocytosis / Q000209:etiology*
D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate