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Roeser A, Moulis G, Ebbo M, Terriou L, Poullot E, Lioger B, Chilles M, Labussière-Wallet H, Mausservey C, Pha M, Puyade M, Cheze S, Limal N, Michel M, Godeau B, Mahévas M. Characteristics, management and outcome of acquired amegakaryocytic thrombocytopenia. Br J Haematol 2022; 198:595-599. [PMID: 35538740 DOI: 10.1111/bjh.18235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anais Roeser
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de l'adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Guillaume Moulis
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; CIC 1436, équipe PEPSS, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,CIC 1436, équipe PEPSS, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, Marseille, France
| | - Louis Terriou
- Service de Médecine Interne et Immunologie Clinique, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Elsa Poullot
- Service d'anatomopathologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Lioger
- Service de Médecine Interne, Hôpital Simone Veil, Blois, France
| | - Marie Chilles
- Service de Médecine Interne, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Helene Labussière-Wallet
- Service d'hématologie Clinique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Micheline Pha
- Service de médecine interne, Centre de référence du lupus, syndrome des anticorps antiphospholipides et autres maladies auto-immunes rares, Groupement Hospitalier Pitié-Salpêtrière (GHPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Mathieu Puyade
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Stephane Cheze
- Institut d'Hématologie de Basse-Normandie, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Nicolas Limal
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de l'adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de l'adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de l'adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de l'adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
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2
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Tu X, Xue A, Wu S, Jin M, Zhao P, Zhang H. Case Report: Successful Avatrombopag Treatment for Two Cases of Anti-PD-1 Antibody-Induced Acquired Amegakaryocytic Thrombocytopenia. Front Pharmacol 2022; 12:795884. [PMID: 35153753 PMCID: PMC8830913 DOI: 10.3389/fphar.2021.795884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anti-PD-1/PD-L1 immunotherapy has achieved impressive responses in multiple types of malignancies in recent years. However, immune-related adverse events (irAEs) occur and limit their continuous clinical use. Among these irAEs, acquired amegakaryocytic thrombocytopenia (AAT) is rare but often clinically serious, life-threatening and refractory to multiple treatment approaches. Case summary: We reported for the first time the successful treatment of avatrombopag in two cases of anti-PD1 antibody-induced AAT (in particular, one case had progressed to aplastic anemia), which was refractory or intolerant to glucocorticoids, ciclosporin, intravenous immunoglobulin (IVIG), recombinant human thrombopoietin (rh-TPO) and even TPO receptor agonist (TPO-RA) eltrombopag. To date, the two cases manifested as normal platelet counts and are independent of transfusion. Conclusion: Anti-PD1 antibody-induced AAT occurs with low frequency but is often serious and difficult to manage, for which this study proposed vatrombopag as a potential curative and safe approach.
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Affiliation(s)
- Xiaofang Tu
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ali Xue
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Suye Wu
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mengmeng Jin
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pu Zhao
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Zhang
- Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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3
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Transient acquired amegakaryocytic thrombocytopenia associated with Pediatric Hodgkin Lymphoma: A case report. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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4
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Suyama T, Hagihara M, Kubota N, Osamura Y, Shinka Y, Miyao N. Acquired amegakaryocytic thrombocytopenia after durvalumab administration. J Clin Exp Hematop 2021; 61:53-57. [PMID: 33431742 PMCID: PMC8053569 DOI: 10.3960/jslrt.20047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs), despite their ability to potentiate antitumor T-cell
responses, may cause various immune-related adverse events. Most cases of thrombocytopenia
induced by ICIs have revealed a pathophysiologic mechanism of immune thrombocytopenia with
increased platelet destruction and preserved megakaryocytes. Acquired amegakaryocytic
thrombocytopenic purpura (AATP) is an unusual disorder characterized by thrombocytopenia
with markedly diminished bone marrow megakaryocytes in the presence of otherwise normal
hematopoiesis. AATP caused by ICIs has not been reported on. Herein, we present the case
of a 79-year-old man diagnosed with squamous cell carcinoma of the lung who developed AATP
after two courses of durvalumab, a drug targeting programmed death-ligand 1. Two weeks
after the second cycle, his platelet count decreased to 2.1 × 104/μL. After the
patient underwent platelet transfusion, his platelet count increased to 8.1 ×
104/μL the next day but subsequently decreased repeatedly even after the ICI
was discontinued. Six weeks after the second cycle, he developed interstitial pneumonia
and was administered prednisolone (50 mg/day). However, thrombocytopenia did not improve.
Bone marrow biopsy showed scarce megakaryocytes (< 1 megakaryocyte/10 high-power
fields) with preservation of myeloid and erythroid series. Myelodysplasia, myelofibrosis,
or metastatic lesions were not observed. Cytogenetic analysis showed a normal male
karyotype of 46XY. Hence, the patient received eltrombopag, a thrombopoietin receptor
agonist, and his platelet count subsequently improved. After recovery, bone marrow
aspiration revealed a normal number of megakaryocytes. AATP is rarely the type of
thrombocytopenia induced by ICIs and may be successfully treated with thrombopoietin
receptor agonists.
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Affiliation(s)
- Takahiro Suyama
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Taito, Tokyo, Japan
| | - Naoto Kubota
- Pathology, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoko Shinka
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Naoki Miyao
- Departments of Internal Medicine,Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
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5
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Dragani M, Andreani G, Familiari U, Marci V, Rege-Cambrin G. Pure red cell aplasia and amegakaryocytic thrombocytopenia in thymoma: The uncharted territory. Clin Case Rep 2020; 8:598-601. [PMID: 32274018 PMCID: PMC7141733 DOI: 10.1002/ccr3.2642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/05/2022] Open
Abstract
Association between thymoma and pure red cell aplasia is already well-documented in literature whereas acquired amegakaryocytic thrombocytopenia is rarely reported. In this case, even with the addition of eltrombopag to standard immunosuppression, the cytopenias did not improve, probably due to the lack of surgical resection of the tumor.
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Affiliation(s)
- Matteo Dragani
- Azienda Ospedaliero Universitaria San Luigi Gonzaga Università di Torino Orbassano Italy
| | - Giacomo Andreani
- Azienda Ospedaliero Universitaria San Luigi Gonzaga Università di Torino Orbassano Italy
| | - Ubaldo Familiari
- Azienda Ospedaliero Universitaria San Luigi Gonzaga Università di Torino Orbassano Italy
| | - Valerio Marci
- Azienda Ospedaliero Universitaria San Luigi Gonzaga Università di Torino Orbassano Italy
| | - Giovanna Rege-Cambrin
- Azienda Ospedaliero Universitaria San Luigi Gonzaga Università di Torino Orbassano Italy
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6
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Ichikawa T, Shimojima Y, Otuki T, Ueno KI, Kishida D, Sekijima Y. Acquired Amegakaryocytic Thrombocytopenia in Adult-onset Still's Disease: Successful Combination Therapy with Tocilizumab and Cyclosporine. Intern Med 2019; 58:3473-3478. [PMID: 31391399 PMCID: PMC6928498 DOI: 10.2169/internalmedicine.2929-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adult-onset Still's disease (AOSD) sometimes demonstrates hematologic disorder, whereas acquired amegakaryocytic thrombocytopenia (AAT) involvement is extremely rare. We herein report a 67-year-old woman with relapse of AOSD who concomitantly developed AAT. Thrombocytopenia along with high disease activity of AOSD was resistant to high-dose prednisolone, even in combination with methotrexate and tacrolimus. However, alternative treatment with cyclosporine after administering tocilizumab resulted in the improvement of thrombocytopenia, ultimately demonstrating that combination therapy based on suppressing the intractable disease activity of AOSD and subsequently adding a reliable immunosuppressant was required to achieve remission.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Toshiaki Otuki
- Department of Laboratory Medicine, Shinshu University Hospital, Japan
| | - Ken-Ichi Ueno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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7
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Min YN, Wang CY, Li XX, Hou Y, Qiu JH, Ma J, Shao LL, Zhang X, Wang YW, Peng J, Hou M, Shi Y. Participation of B-cell-activating factor receptors in the pathogenesis of immune thrombocytopenia. J Thromb Haemost 2016; 14:559-71. [PMID: 26749059 DOI: 10.1111/jth.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/20/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED ESSENTIALS: Dysfunctional B-cell-activating factor (BAFF) system is related to many autoimmune diseases. The regulatory functions of BAFF/BAFF receptors were investigated in an in vitro coculture system. Different regulatory roles of BAFF were investigated via different receptors in immune thrombocytopenia. The upregulated BAFF receptors on autoreactive lymphocytes lead to their hypersensitivity to BAFF. SUMMARY BACKGROUND The pathogenesis of immune thrombocytopenia (ITP) remains enigmatic. B-cell-activating factor (BAFF) and its receptors (BAFF receptor [BAFF-R], transmembrane activator and calcium modulator and cyclophilin ligand interactor [TACI], and B-cell maturation antigen) play central roles in the integrated homeostatic regulation of lymphocytes. OBJECTIVES To investigate the pathologic roles of BAFF receptors in regulating the bioactivities of lymphocytes in ITP. METHODS An in vitro culture system was established by stimulating CD14(-) peripheral lymphocytes with platelet-preloaded dendritic cells in the presence of recombinant human BAFF (rhBAFF; 20 ng mL(-1)). The functions of BAFF receptors were specifically blocked with blocking antibodies. RESULTS BAFF-R, besides prolonging the survival of B cells in both patients and healthy controls, prominently promoted the survival of CD8(+) T cells and the proliferation of B cells in patients with ITP. TACI, as a positive regulator, not only promoted the proliferation of CD4(+) and CD8(+) T cells, but also significantly enhanced the secretion of interleukin-4 in patients with ITP, but not in controls. Besides revealing the pathologic roles of BAFF receptors, these results also indicate that lymphocytes of patients with ITP have enhanced antiapoptotic or proliferative capacity as compared with those from healthy controls when exposed under similar stimulation of rhBAFF. Further study demonstrated that activated autoreactive B cells and CD4(+) T cells from patients with ITP showed significantly higher expression of BAFF-R or TACI than those from healthy controls. CONCLUSIONS Both BAFF-R and TACI are pathogenic participants in ITP. Their dysregulated expression in patients with ITP may lead to hyperreactivity of activated autoreactive lymphocytes in response to rhBAFF, and thus is highly significant in the pathogenesis of ITP.
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Affiliation(s)
- Y-N Min
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - C-Y Wang
- Department of General Medicine, Second Hospital of Shandong University, Jinan, Shandong, China
| | - X-X Li
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Y Hou
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J-H Qiu
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J Ma
- Department of General Medicine, Medical Research Institute for Tumor Prevention and Cure, Shandong University, Jinan, Shandong, China
| | - L-L Shao
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - X Zhang
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Y-W Wang
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J Peng
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, Shandong, China
| | - M Hou
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, Shandong, China
| | - Y Shi
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
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8
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Mulroy E, Gleeson S, Chiruka S. Danazol: an effective option in acquired amegakaryocytic thrombocytopaenic purpura. Case Rep Hematol 2015; 2015:171253. [PMID: 25945269 PMCID: PMC4402186 DOI: 10.1155/2015/171253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 11/18/2022] Open
Abstract
Acquired amegakaryocytic thrombocytopaenic purpura (AATP) is a rare haematological condition characterised by isolated thrombocytopaenia with normal other cell lines. It is often initially misdiagnosed as immune thrombocytopaenic purpura but has characteristic bone marrow findings of reduced megakaryocyte numbers. The optimal treatment of AATP is not clearly defined but revolves around immunosuppressive therapies. We report a case of successful treatment of AATP with danazol, an antioestrogenic medication. We also review the aetiologies and pathogenesis of the disorder and suggest that danazol should be considered as an effective alternative to potent immunosuppression in AATP.
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Affiliation(s)
- E. Mulroy
- Department of Haematology, Dunedin Hospital, Great King Street, Dunedin 9016, New Zealand
| | - S. Gleeson
- Department of Haematology, Dunedin Hospital, Great King Street, Dunedin 9016, New Zealand
| | - S. Chiruka
- Department of Haematology, Dunedin Hospital, Great King Street, Dunedin 9016, New Zealand
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9
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Liu X, Hou Y, Peng J. Advances in immunopathogenesis of adult immune thrombocytopenia. Front Med 2013; 7:418-24. [DOI: 10.1007/s11684-013-0297-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
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10
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Successful treatment of acquired amegakaryocytic thrombocytopenic purpura refractory to corticosteroids and intravenous immunoglobulin with antithymocyte globulin and cyclosporin. Int J Hematol 2008; 88:223-226. [DOI: 10.1007/s12185-008-0125-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
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11
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Li S, Wang L, Zhao C, Li L, Peng J, Hou M. CD8+ T cells suppress autologous megakaryocyte apoptosis in idiopathic thrombocytopenic purpura. Br J Haematol 2008; 139:605-11. [PMID: 17979946 DOI: 10.1111/j.1365-2141.2007.06737.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the effect and mechanism of the CD8+ T cells in bone marrow on autologous megakaryocytopoiesis in idiopathic thrombocytopenic purpura (ITP) patients, we prepared bone marrow mononuclear cells (MNCs) from 15 chronic ITP patients and 13 controls. MNCs were cultured in vitro directly (MNC group) or after depleting CD8+ T cells (CD8+ T-dep group) or adding purified autologous CD8+ T cells to CD8+ T-dep MNCs (Coculture group) or adding dexamethasone to the coculture (DEX group) all in semi-solid and liquid culture systems. The quantity and quality of megakaryocytes were measured. The megakaryocyte count was increased in the presence of autologous CD8+ T cells of patients with chronic ITP, while platelet production was reduced. In addition, lower percentages of polyploidy and apoptotic megakaryocytes, and higher levels of soluble Fas (sFas) in supernatant were observed. Dexamethasone successfully corrected this effect of CD8+ T cells on autologous megakaryocytopoiesis. These studies provide evidence that activated CD8+ T cells in bone marrow of patients with chronic ITP might suppress megakaryocyte apoptosis, leading to impaired platelet production. Megakaryocyte apoptosis would be a novel target for the management of ITP.
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Affiliation(s)
- Shuguang Li
- Haematology Oncology Centre, Qilu Hospital of Shandong University, Jinan, Shandong, China
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12
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Witteles WH, Schrier SL, Wakelee HA. Lung Cancer Presenting With Amegakaryocytic Thrombocytopenia. J Clin Oncol 2008; 26:1171-4. [DOI: 10.1200/jco.2007.14.8106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wesley H. Witteles
- Division of Hematology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA
| | - Stanley L. Schrier
- Division of Hematology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA
| | - Heather A. Wakelee
- Division of Oncology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA
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13
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Agarwal N, Spahr JE, Werner TL, Newton DL, Rodgers GM. Acquired amegakaryocytic thrombocytopenic purpura. Am J Hematol 2006; 81:132-5. [PMID: 16432869 DOI: 10.1002/ajh.20510] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acquired amegakaryocytic thrombocytopenia is an unusual hematologic disorder characterized by thrombocytopenia in association with markedly diminished bone marrow megakaryocytes. We report a case that responded to treatment with cyclosporine but not to IL-11. The bone marrow biopsy, repeated after resolution of thrombocytopenia, showed normal number of megakaryocytes.
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Affiliation(s)
- Neeraj Agarwal
- Division of Hematology, Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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14
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Tristano AG. Acquired amegakaryocytic thrombocytopenic purpura: review of a not very well-defined disorder. Eur J Intern Med 2005; 16:477-81. [PMID: 16275539 DOI: 10.1016/j.ejim.2005.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Accepted: 04/01/2005] [Indexed: 11/17/2022]
Abstract
Acquired amegakaryocytic thrombocytopenic purpura (AATP) is a hematological disorder characterized by severe thrombocytopenia, probably due to an immunologically induced absence of megakaryocytes with a marked decrease or total absence of megakaryocytes in the bone marrow. AATP may be differentiated from other causes of peripheral destruction of platelets, such as immune thrombocytopenia (ITP). Currently, there are no standard treatments for AATP. However, immunosuppressive therapy including steroids, androgens, anti-thymocyte globulin (ATG), cyclophosphamide, cyclosporine A, immunoglobulins, splenectomy, and allogenic bone marrow transplantation (BMT) have all been utilized with varying degrees of success. However, a positive response in patients with AATP using steroids alone has rarely been reported in the literature.
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Affiliation(s)
- Antonio G Tristano
- Department of Internal Medicine, Hospital Dr. Domingo Luciani, Caracas, Venezuela.
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15
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Lachowicz JL, Post GS, Moroff SD, Mooney SC. Acquired amegakaryocytic thrombocytopenia - four cases and a literature review. J Small Anim Pract 2004; 45:507-14. [PMID: 15515801 DOI: 10.1111/j.1748-5827.2004.tb00197.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acquired amegakaryocytic thrombocytopenla was diagnosed in four dogs. Initial platelet counts in all four dogs were less than 50,000 x 10(9)/litre and initial bone marrow examinations revealed megakaryocytic hypoplasia with minimal changes in the erythroid and myeloid cell lines. Two dogs had evidence of idiopathic immune-mediated disease and two dogs had evidence of associated infectious disease. One dog had a positive antibody titre to Borrella burgdorferi, and one dog had positive titres to both Ehrlichia canis and B. burgdorferi. Treatment consisted of prednisone and cyclophosphamide for the dogs with presumptive immune-mediated disease, and prednisone and tetracycline for the dogs with positive antibody titres to the Infectious organisms. Both dogs with evidence of associated infectious disease responded to treatment. A postmortem examination did not reveal the underlying aetiology in the two dogs with presumptive idiopathic immune-mediated disease.
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Affiliation(s)
- J L Lachowicz
- Veterinary Oncology and Hematology Center, LLC, 123 West Cedar Street, Norwalk, CT 06854, USA
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16
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Felderbauer P, Ritter PR, Mattern D, Schmitz F, Bulut K, Ansorge N, Schmitt-Graeff A, Schmidt WE, Baier JE. Acquired pure megakaryocytic aplasia: a separate haematological disease entity or a syndrome with multiple causes? Eur J Haematol 2004; 72:451-4. [PMID: 15128427 DOI: 10.1111/j.1600-0609.2004.00241.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the case of a patient with acquired pure megakaryocytic aplasia. Until today, less than 20 cases of acquired pure megakaryocytic aplasia have been reported and the disease aetiology still seems to be unclear. This report summarizes the published data concerning possible aetiologies, treatment options and outcome of patients with acquired pure megakaryocytic aplasia. Furthermore, this case report presents an example for a possible disease progression.
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Affiliation(s)
- P Felderbauer
- Department of Medicine I, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Kuwana M, Okazaki Y, Kajihara M, Kaburaki J, Miyazaki H, Kawakami Y, Ikeda Y. Autoantibody to c-Mpl (thrombopoietin receptor) in systemic lupus erythematosus: relationship to thrombocytopenia with megakaryocytic hypoplasia. ARTHRITIS AND RHEUMATISM 2002; 46:2148-59. [PMID: 12209520 DOI: 10.1002/art.10420] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the prevalence, clinical associations, and pathogenic role of autoantibodies to c-Mpl, the thrombopoietin (TPO) receptor, in patients with systemic lupus erythematosus (SLE). METHODS Sera from 69 SLE patients, 84 patients with idiopathic thrombocytopenic purpura (ITP), and 60 healthy individuals were screened for anti-c-Mpl antibodies by enzyme-linked immunosorbent assay using recombinant c-Mpl as an antigen. Clinical findings, autoantibody profiles, and serum TPO levels were compared between SLE patients with and without anti-c-Mpl antibodies. A pathogenic role for the anti-c-Mpl antibody was evaluated by examining its inhibitory effect on TPO-dependent cell proliferation and megakaryocyte colony formation. RESULTS Serum anti-c-Mpl antibody was detected in 8 SLE patients (11.6%) and 7 ITP patients (8.3%), but in none of the healthy controls. Anti-c-Mpl antibody was associated with thrombocytopenia (P = 0.0002) and a decrease in bone marrow megakaryocytes (P = 0.02) in SLE patients. Serum TPO levels in thrombocytopenic SLE patients with anti-c-Mpl antibodies were significantly elevated compared with levels in those without the antibodies (P = 0.007). IgG fractions purified from anti-c-Mpl antibody-positive sera bound to c-Mpl expressed on the cell surface and inhibited TPO-dependent cell proliferation and megakaryocyte colony formation. CONCLUSION Autoantibody to c-Mpl is present in a subset of SLE patients with thrombocytopenia and megakaryocytic hypoplasia. It is likely that the impaired thrombopoiesis in these patients is mediated by the anti-c-Mpl antibody, which functionally blocks an interaction between TPO and c-Mpl.
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MESH Headings
- Adolescent
- Adult
- Aged
- Animals
- Autoantibodies/immunology
- Bone Marrow Cells/pathology
- Cell Division/drug effects
- Colony-Forming Units Assay
- Dose-Response Relationship, Immunologic
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/immunology
- Male
- Megakaryocytes/pathology
- Megakaryocytes/physiology
- Middle Aged
- Neoplasm Proteins
- Proto-Oncogene Proteins/blood
- Proto-Oncogene Proteins/immunology
- Proto-Oncogene Proteins/pharmacology
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Receptors, Cytokine
- Receptors, Thrombopoietin
- Recombinant Proteins/blood
- Recombinant Proteins/immunology
- Recombinant Proteins/pharmacology
- Transfection
- Tumor Cells, Cultured
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