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Forum Name: Hematology Topics

Question: High lymphocyte count low MPV


 johnsmom1 - Wed Jul 21, 2010 6:27 pm

Hello my one year old son has been extremely tired for the past 5 weeks and he's bruising very easy and for no reason at all sometimes.. He's not really eating much and he's awake maybe 4 hours a day he's very cranky and under his eyes are swollen.. He did have blood work done and his lymphocyte count wAs 71... His absolute lymphocyte count was 5700..and his atypical lymphocyte was 1..MPV was 6... Neutrophils was 19..they said they would retest his in august but these symptoms are going on for 5 weeks now... Not sure if I should wait or go for a second opinion do these results seem concerning with the symptoms he's having??
 Dr.M.Aroon kamath - Sun Aug 01, 2010 6:28 am

User avatar Hi,
As not a great deal of details have been provided in your post, I will confine myself to providing you some information on the various differential diagnoses that may need to be considered in such a case scenario.

The normal mean platelet volume (MPV) ranges between 7.5-11.5 fl.

Whenever the MPV is decreased, it means the platelets are smaller than normal. They are known as microthrombocytes.

Microthrombocytosis may indicate the following disorders:
- Aplastic Anemia : A rare acquired disorder in which the bone marrow stops producing new blood cells.
- Wiskott-Aldrich Syndrome: An inherited immune deficiency disease, one of whose main symptom is a tendency to bleed due to a low platelet count.
- Thrombocytopenia-absent radii (TAR Syndrome:) A rare disorder in which there are low platelets and absence of the radius bones in the arms.
- Storage Pool Disease: one of the several types of storage pool disorders , when involving plateles, results in a mild bleeding disorder that causes bruising.

One may suspect the type of bleeding disorder based on the age of onset.
At birth: maternal idiopathic thrombocytopenic purpura, maternal systemic lupus erythematosus, intrauterine infections, maternal medications, TAR syndrome, and congenital amegakaryocytic thrombocytopenia.
2 to 4 years: Idiopathic thrombocytopenic purpura (ITP).
4 to 7 years: Henoch-Schönlein purpura.

Platelet storage pool disorders: can be congenital or acquired and result from a deficiency of granules (alpha or dense granules, or both) or a defective release of granules at platelet activation..Acquired platelet storage pool disorders may be associated with underlying myeloproliferative disorders, disseminated intravascular coagulation, and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.

TAR syndrome (amegakaryocytic thrombocytopenia syndrome): An association of phocomelia with thrombocytopenia and a decrease in the number of megakaryocytes on the myelogram was described, the TAR syndrome(thrombocytopenia with absent radii- but thumbs and digits are almost always present), a rare congenital disorder that differs from the myelodysplastic syndrome in that no changes occur in granulocytic and erythroid series. They frequently are associated with relative hypogammaglobulinemia,

Acute immune thrombocytopenic purpura (ITP): in most cases, particularly in children, is mild and self-limited and may not come to medical attention. In children, immune thrombocytopenic purpura (ITP) is more common among boys compared with girls. The prevalence peaks between 1-6 years of age. In children, most cases are acute, frequently manifesting a few weeks after a viral illness. Immune mediated thrombocytopenia (ITP) is a common manifestation of autoimmune disease in children. Although patients often present with petechiae, bruises, and some mucosal bleeding, the incidence of life-threatening hemorrhage is rare (0.2–0.9%) but can be fatal if bleeding occurs in vital organs.

Neonates may also have a form of immune thrombocytopenia with extensive bruising and thrombocytopenia called neonatal alloimmune thrombocytopenic purpura (NATP). The platelet destruction here is secondary to transplacental maternal IgG alloantibodies, rather than autoantibodies. Platelets are large sized (giant or "dust-like").Thus MPV will be often raised.

Onyalai: is a rather mysterious disease, is a special type of aquired immune thrombocytopenia in Africa (in some parts of countries in central southern Africa such as, southern Angola and northern Namibia). Cause is unknown although, plant toxins have been implicated in the etiology. Clinical presentation apart form bleeding in the skin and mucus membranes, is associated with typical hemorrhagic bullae in the oral mucosa.Can present at any age (including infancy). The platelets in this disease are morphologically normal. Most patients recover and the platelet counts return to normal slowly. However, it may frequently relapse or may become chronic. Infants of mothers with onyalai, unlike infants of mothers with idiopathic thrombocytopenic purpura, do not appear to be at risk of thrombocytopenia and haemorrhage.

Drug-induced thrombocytopenia: several drugs(including analgesics) can produce thrombocytopenia as an advese drug reaction.

One must remember that the lymphocyte counts in the new borns and infants are normally higher than in adults. At age 1, Mean absolute lumphocyte count is about 7.0/µL(range 4-10.5).

So your child’s absolute lymphocyte count is within normal limits. The cause of the bleeding and raised MPV will need to be investigated comprehensively, sooner rather than later.
Good luck!

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