Idiopathic thrombocytopenic purpura associated with bone marrow sea-blue histiocytosis

✍ Scribed by Siddhartha Ganguly; Mark T. Cunningham

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 142 KB
• Volume: 77
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.20248

✦ Synopsis

A 28-year-old Caucasian female presented to the outpatient clinic of the University Hospital with a 2-year history of intermittent bruising and menorrhagia. Her past history and family history were unre-markable. Physical examination was entirely normal. Her complete blood count included a hemoglobin of 13.9 g/dL; a white blood count of 6.4 Â 10 9 /L with a normal differential; and a platelet count that ranged from 23 Â 10 9 to 49 Â 10 9 /L. Bone marrow aspirate and biopsy specimens demonstrated normal numbers and normal maturation of both myeloid and erythroid precursors. However, there was striking evidence of megakaryocytic hyperplasia (see Image 1). The presence of megakaryocytic hyperplasia, along with the fact that many of the megakaryocytes were very immature, provides support for the diagnosis of immune thrombocytopenic purpura (ITP). The most Image 1. Bone marrow biopsy showing megakaryocytic hyperplasia (hematoxylin-eosin stain, original magnification 200•). Image 2. Sea-blue histiocyte (black arrow) immediately adjacent to an immature megakaryocyte (green arrow) (Wright's stain, original magnification 1000•). Image 3. Bone marrow aspirate showing sea-blue histiocytes (arrow) (Wright's stain, original magnification 500•).