Dysplastic changes in idiopathic thrombocytopenic purpura and the effect of corticosteroids to increase dysplasia and cause hyperdiploid macropolycytes

This study evaluates the dysplastic hematological changes in nine patients with idiopathic thrombocytopenic purpura (ITP) in 11 attacks, before and af ter corticosteroid treatment. The pretreatment blood smears of patients wit h ITP, displayed more neutrophils with bizarre nuclei (P < 0.001), Dohle or Dohle-like inclusions (P < 0.01), irregular distribution of granules (P < 0.05), hypo-agranulation (P < 0.05), pseudo-Pelger-Huet-like cells (P < 0.0 1), and nuclei with chromatine clumping (P < 0.01) than the normal children . The eosinophils of ITP patients were also dysplastic, before treatment. T he pretreatment diameter of the neutrophils and the percentage of macropoly cytes were greater than those of the patients with viral infections and nor mal group (P < 0.05 for all). The percentage of neutrophils with bizarre nu clei and nuclei with chromatine clumping and the diameter of neutrophils an d macropolycyte percentage increased with corticosteroid therapy (P < 0.01, < 0.01, < 0.01, and < 0.05, respectively). The neutrophil diameter, percen tage of macropolycytes, and number of neutrophils with bizarre nuclei decre ased within 1-4 weeks after the therapy was stopped. In the neutrophils of two patients, diploidy and hyperdiploidy were established before and on the last day of therapy, respectively, and diploidy reversed after therapy was stopped. In conclusion, ITP patients display dysplastic findings in both n eutrophils and eosinophils before treatment and corticosteroids cause trans ient significant increase in some of the dysplastic changes in neutrophils, (C) 2000 Wiley-Liss, Inc.