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