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To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML patient cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below).

Each clinical case will be forwarded to the iCMLf expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are only accepted from clinicians. If individual patients have a specific question we encourage them to contact their healthcare provider.

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

TOPIC: ITP like phenomenon?

ITP like phenomenon? 4 months 3 weeks ago #1703

  • Saurabh Bhave
  • Saurabh Bhave's Avatar
I have a case. I need an opinion.

50 year old lady from Bhutan. CML since 2009. On regular imatinib 400 mg OD. no regular RQ-PCR done.
Has come to TMC, Kolkata with Platelet count of 5000, HB 7 g and TLC of 5000 .BM: 11-15 % blasts which are of myeloid type. She has adequate megakaryocytes in marrow

Questions:
1.She has low platelet count inspite of adequate megs. in marrow? How do we explain this? Does she have ITP like phenomenon

Regards

Saurabh

ITP like phenomenon? 4 months 3 weeks ago #1704

  • Andreas Hochhaus
  • Andreas Hochhaus's Avatar
Here, is simple hematological workup is required.
The most likely reason for the discrepancy is pseudothrombopenia, which can be easily revealed using blood slides or citrate blood.
Immune thrombopenia is accompanied by young left shifted megakaryocytes and platelet antibodies.

kind regards
Andreas
Last Edit: 4 months 3 weeks ago by Nicola.

ITP like phenomenon? 4 months 3 weeks ago #1705

  • Saurabh Bhave
  • Saurabh Bhave's Avatar
Further comment: We had checked in citrate vacutainer and still the platelet counts is low

ITP like phenomenon? 4 months 3 weeks ago #1706

  • Andreas Hochhaus
  • Andreas Hochhaus's Avatar
Immune Mechanism possible.
Platelet antibodies?
Megakarycyte morphology ?
Left shift of megakaryocytes?
Response to corticoids?

Andreas

ITP like phenomenon? 4 months 3 weeks ago #1707

  • Sadashivudu Gundeti
  • Sadashivudu Gundeti's Avatar
We have reported one case of imatinib induced immune thrombocytopenia 8 years ago.We have confirmed it by Bone marrow examination.
With steroids and discontinuation of Imatinib platelet count recovered. Again he developed same problem with reinitiation of Imatinib.
At last we have reduced the dose of Imatinib to 300mg. Now patient is doing well.
Last Edit: 4 months 3 weeks ago by Nicola.
Moderators: Melissa Davis-Bishop
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