Chronic myelomonocytic leukemia developed 2 years after the onset of immune thrombocytopenic purpura like syndrome

An 80-year old man was diagnosed as having immune thrombocytopenic purpura based on epistaxis, purpura and by the platelet count 8 x 10(9)/l. Predniso lone and gamma globulin were administered and the platelet count had been k ept around 50 x 10(9)/l during his follow up. Two years from the onset of i mmune thrombocytopenic purpura he was admitted because of leukocytosis (79 x 10(9)/l with 79% monocytes), anemia and thrombocytopenia. Hypercellular b one marrow with dysplasia of three lineages was observed. In the bone marro w cytogenic analysis, a -6, clonal cytogenic abnormality was observed, 45XY , der(6), t(6;6)(q16;q23). He was diagnosed as having chronic myelomonocyti c leukemia. This is a difficult case in which it was diagnosed as refractor y thrombocytopenia as a subgroup of myelodysplastic syndrome, rather than i mmune thrombocytopenic purpura, which might have preceded the development o f chronic myelomonocytic leukemia.