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Forum Name: Hematology Topics

Question: Severe Thrombocytopenia


 sunspin - Mon Jul 23, 2007 2:52 pm

Hi Doctor,

Iam 27 years old, Sex:Male.
I have been experiencing nose bleeds in the month of February and had a primary check in April and was found thrombocytopenic. Also I shud mention that I was anemic since childhood but never had low platelets. My blood counts then are as below:

Date HB(12-18) ; WBC(4-10) ; Platelets(1.4 - 3.0lac)
April 8.2 ; 4.7 ; 35000

Then I was sent to a Hematologist and he found that my ferratin and Vitamin B12 are low. I was given 500ml of Iron infusion weekly B12 shots and folic acid tabs for one month, then my counts were monitored. They came as below:

Date HB ; WBC ; Platelets
May 1stweek - 8.5 ;4.7 ; 34000
May 2nd week - 8.9 ;4.7 ;35000
May 3rd week - 8.9 ;4.7 ; 32000
May 4th week - 9.2 ;4.7 ;33000

June 1st week - 9.5 ;4.7 ; 32000
June 3rd week - 9.9 ; 4.7 ; 30000
Then on july 2nd they did my bone marrow as all the blood test they
sent
out came back negative. And my counts from july 2nd:

Date HB ; WBC ; Platelets
july 2nd - 9.9 ; 4.7 ;32000
july 9th - 8.9 ;4.7 ;28000
july 12th - 9.3 ;5.8 ;27000
july 16th - 9.3 ;4.7 ;30000
july 23rd - 9.4 ;5.8 ;30000
All my bone marrow tests including chromosome tests came back negative but with one finding that there are no megakaryocytes in my marrow. My
oncologist is unable to findout what is the reason behind that and he wants to refer me to jhon hopkins in Maryland US. But before doing that he wants me to wait for 3 more weeks, but am already feeling pains in my muscles in hands and legs and slowly am finding small red spots on my skin. Am worried what to do. Please explain me, what is happening with me and what should i do now!?

And I recently discovered my previous blood reports like on year 98 and 2005. The counts are as below:


98'Dec -- WBC - 10,300/cumm, HB - 13.2gms%, platelets - says adequate(No Count specified)
Jun 2005 -- No WBC specified, HB - 9.8g/ml , platelets - says adequate(No Count specified)

And had amoebiasis in year 98. A stool test showed:
ova of: lumbricoides (3/pp)
cysts of: E.hystolytica: Present

Thanks,
Sunil.
 Dr. Chan Lowe - Wed Jul 25, 2007 4:54 pm

User avatar Hi Sunspin,

Based on your previously higher platelet level you do not have congential absence of megakaryocytes (the cells that produce platelets). There is a very rare entity known as aquired megakaryocyte aplasia. I think this is less likely to be the case, though, because your red cells seem to be affected also.

There is another, also rare, condition known as Evan's syndrome where antibodies attack the red cells and the platelets. I am not certain that the megakaryocytes are destroyed in this condition. I do not believe that they are.

It appears that you had some response to the iron infusions so your low RBC's may, at least in part, be due to iron deficiency.

The red dots you are seeing are likely petechiae. These represent small areas of bleeding in the capillaries that occurs when platelets are low. In themselves they are harmless. They generally are the tip off that the platelets are low.

I would agree that you should pursue further work up and being seen at John's Hopkins is a good choice. If your hematologist feels you should wait 3 weeks I would recommend you do so. If you are concerned you should talk with your hematologist. You may be able to get some more information that will make you feel better, or you may both decide to refer you sooner.

Best wishes.

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