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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).

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ITP like phenomenon?

  • Saurabh Bhave
  • Saurabh Bhave's Avatar Topic Author
6 months 2 weeks ago #1703 by Saurabh Bhave
ITP like phenomenon? was created by Saurabh Bhave
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
  • Andreas Hochhaus
  • Andreas Hochhaus's Avatar Topic Author
6 months 2 weeks ago - 6 months 2 weeks ago #1704 by Andreas Hochhaus
Replied by Andreas Hochhaus on topic 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.

kind regards
Andreas
Last edit: 6 months 2 weeks ago by Nicola.
  • Saurabh Bhave
  • Saurabh Bhave's Avatar Topic Author
6 months 2 weeks ago #1705 by Saurabh Bhave
Replied by Saurabh Bhave on topic ITP like phenomenon?
Further comment: We had checked in citrate vacutainer and still the platelet counts is low
  • Andreas Hochhaus
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6 months 2 weeks ago #1706 by Andreas Hochhaus
Replied by Andreas Hochhaus on topic ITP like phenomenon?
Immune Mechanism possible.
Platelet antibodies?
Megakarycyte morphology ?
Left shift of megakaryocytes?
Response to corticoids?

Andreas
  • Sadashivudu Gundeti
  • Sadashivudu Gundeti's Avatar Topic Author
6 months 2 weeks ago - 6 months 2 weeks ago #1707 by Sadashivudu Gundeti
Replied by Sadashivudu Gundeti on topic ITP like phenomenon?
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: 6 months 2 weeks ago by Nicola.
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