Clinical analysis and TPO levels in three patients with refractory thrombocytopenia

Refractory thrombocytopenia (RTC) is a counter-concept to refractory anemia , which is characterized by isolated thrombocytopenia associated with clona l chromosomal abnormality. The diagnosis of RTC is difficult to establish b ased on morphologic features alone. And steroid therapy for RTC is often in effective. We examined 3 patients with RTC to identify its characteristics and measured serum thrombopoietin levels. The mean platelet count was 5.1 x 10(4)/mu l and the mean age was 64 years. None of our patients had clinica l nor laboratory evidence of liver dysfunction, renal disease or disseminat ed intravascular coagulation. All patients were negative for antiplatelet a ntibody, PA-IgG and anticardiolipin-beta 2GPI antibody. Leukocyte alkaline phosphatase level was low in two patients, Clonal chromosomal abnormalities of different types were detected in all patients. Bone marrow smears showe d micromegakaryocytes. But there were no apparent morphological abnormaliti es of erythroid and granuloid series. Thrombopoietin levels, as determined by enzyme-linked immunosorbent assay, varied from <0.2 to 1.40 fmol/ml. We could not find the screening tool of RTC. In conclusion, there is a need to identify RTC from isolated thrombocytopenia because the patients with RTC don't have good prognosis as patients with isolated thrombocytopenia. Cytog enetic analysis is necessary to establish the diagnosis of RIG. We recommen d that a patient above 50 years of age presenting with isolated thrombocyto penia and a low leukocyte alkaline phosphatase score should be suspected of having RTC. Am. J. Hematol. 62:103-105 1999. (C) 1999 Wiley-Liss, Inc.