Acquired platelet dysfunction with eosinophilia in children in the south of Thailand

One hundred and sixty-eight children aged 13 months to 12.6 years with acqu ired platelet dysfunction with eosinophilia (APDE) were studied. The male t o female ratio was 1.15:1. All of the children were in good health and no h istory of any drug ingestion was detected. All of the children had widespre ad spontaneous bruising on the extremities, body and face off and on. Sever e bleeding symptoms were detected in 8% of these patients, The number of pl atelets in these children was within the normal range but the platelet morp hology was abnormal in all of them. Eosinophilia was detected in 86% of the se children. Prolonged bleeding time was detected in 53% of these patients. Abnormal platelet adhesiveness was found in 33% of cases. Abnormal platele t aggregation induced by collagen was the most sensitive test in these pati ents. Abnormal ADP release from the platelets was detected in these patient s by the absence of a second wave of aggregation during stimulation of PRP by ADP or epinephrine. Abnormal or no ATP secretion from the platelets duri ng stimulation by ADP, epinephrine or collagen was detected in these patien ts. Ristocetin-induced platelet aggregation was normal in these children. D ecreased or absence of platelet dense granules by TEM study was detected in some patients, These changes in platelet functions and morphology may be d ue to acquired storage pool deficiency of the platelet. Parasitic infection was detected in 56% of these children. About 83% of these children with AP DE bad serum total IgE higher than 100 IU/ml, There was no correlation betw een the number of eosinophils and serum total IgE and the severity of bleed ing symptoms. The majority of children with APDE did not receive any treatm ent except those who had severe bleeding symptoms which required platelet c oncentrate to stop bleeding. In more than 90% of the patients, the bruising or ecchymosis disappeared within 6 months and the abnormal platelet functi ons returned to normal within 4 months, Recurrence of these bleeding syndro mes was detected in 7% of the children.