Thrombocytopenia with Decreased Megakaryocytes

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Abstract
The presenting clinical pictures and courses of 7 patients with thrombocytopenia, decreased megakaryocytes in the marrow, and minimal changes in other hematopoietic cell lines are described. Little information exists in the literature on such patients. Initial bone marrow aspiration and biopsy in all patients showed decreased megakaryocytes with an otherwise normal marrow. Erythrocyte mean corpusclar volume was elevated in 5 of 7 patients. Bone marrow karyotypes of 6 of the 7 patients were normal. 51Cr platelet survival studies with platelet sizing, done in 5 of the 7 patients, showed normal results. In 2 patients the course progressed to aplastic anemia. One of these died 9 mo. after presentation, and 1 responded dramatically to lithium. One patient developed preleukemia and did. The other 4 patients have remained thrombocytopenic but clinically stable. No useful therapy was identified. The differential diagnosis of such patients should include idiopathic thrombocytopenic purpura with misinterpretation of morphologic findings, hereditary and acquired aplastic anemia, preleukemia and systemic lupus erythematosus.