Korean J Hematol.  2011 Jun;46(2):128-134. 10.5045/kjh.2011.46.2.128.

Long-term outcome of isolated thrombocytopenia accompanied by hypocellular marrow

• Yun GW
• Yang YJ
• Song IC
• Baek SW
• Lee KS
• Lee HJ
• Yun HJ
• Kwon KC
• Kim S
• Jo DY

• KMID: 1782778
• DOI: http://doi.org/10.5045/kjh.2011.46.2.128

Abstract

BACKGROUND
Hypocellularity of bone marrow (BM), not associated with significant dyshematopoiesis, is often found in patients with isolated thrombocytopenia, but its clinical implications have not been studied. We prospectively studied the clinical features and natural history of these patients.
METHODS
Adults with isolated thrombocytopenia (platelet counts <100x10(9)/L) in the absence of dyshematopoiesis, cytogenetic abnormalities, or megakaryocytic hyperplasia and who had BM hypocellularity (below 30% in patients aged less than 60 years; below 20% in patients aged 60 years or more) were enrolled at Chungnam National University Hospital between January 2002 and December 2006. They were monitored regularly for changes in platelet counts or development of additional cytopenia.
RESULTS
Twenty patients (17 men and 3 women) were enrolled in the study. The median age was 29 years (range, 18-70 years). At initial presentation, the platelet counts ranged from 12x10(9)/L to 99x10(9)/L (median, 63x10(9)/L) and were >50x10(9)/L in 16 patients (80%). BM cellularity ranged from 5% to 25% (median, 15%) and was < or =10% in 6 patients (30%). During the median 48-month follow-up (range, 12-90 months), platelet counts of 3 of the 20 patients recovered to normal levels (>150x10(9)/L) after 12, 56 and 66 months. Three patients developed pancytopenia after 11, 70 and 90 months. Two patients were consistent with moderate aplastic anemia, and 1 was confirmed as having refractory cytopenia with multilineage dysplasia. In the remainder of the patients, platelet counts remained unchanged.
CONCLUSION
Isolated thrombocytopenia accompanied by hypocellular marrow encompasses a group of heterogeneous conditions.

Keyword

Thrombocytopenia; Idiopathic thrombocytopenic purpura; Bone marrow; Aplastic anemia; Myelodysplastic syndromes

MeSH Terms

Adult
Aged
Anemia, Aplastic
Bone Marrow
Chromosome Aberrations
Follow-Up Studies
Humans
Hyperplasia
Male
Myelodysplastic Syndromes
Natural History
Pancytopenia
Platelet Count
Prospective Studies
Purpura, Thrombocytopenic, Idiopathic
Thrombocytopenia

Figure

• 

  Fig. 1 Relationship among laboratory parameters in patients with isolated thrombocytopenia accompanied by hypocellular marrow. Weak positive correlations were observed between serum erythropoietin (EPO) levels and mean corpuscular volume (MCV) (B) and between bone marrow (BM) cellularity and platelet counts (C). No correlation was observed between serum EPO levels and platelet counts (A), between BM cellularity and Hb levels (D), or between BM cellularity and serum EPO levels (E).

• 

  Fig. 2 Representative bone marrow biopsy findings (hematoxylin and eosin [H&E] stain, ×100). (A) Marked hypocellularity with even cellular distribution (from UPN 1). (B) Marked hypocellularity with focally uneven cellular distribution (UPN 15). (C) Moderate hypocellularity with even cellular distribution (from UPN 14).

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