Abstract
Thrombocytopenia may develop in patients with acute lymphoblastic leukemia (ALL) due to myelosuppression of chemotherapy or relapse. Here we report a pediatric patient with ALL whose platelet counts decreased at the 102nd week of maintenance treatment. Thrombocytopenia was refractory to platelet infusions and bone marrow aspiration revealed remission status for ALL along with increased megakaryocytes. The cessation of chemotherapy for 2 weeks caused no increase in thrombocyte counts. The viral serology was unrevealing. A diagnosis of immune thrombocytopenic purpura (ITP) was established. After administration of intravenous immunoglobulin, the thrombocytopenia resolved. When thrombocytopenia occurs in patients with ALL in remission, ITP should be kept in mind after exclusion of the more common etiologies.
Highlights
Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia due to increased platelet destruction and impaired platelet production [1]
Thrombocytopenia seen in patients with acute lymphoblastic leukemia (ALL) is generally secondary to chemotherapy or relapse of primary disease
Impaired megakaryocytopoiesis may be seen in ITP, but commonly accelerated destruction of platelets results in increased megakaryocytes in bone marrow as a distinctive finding of ITP [1,5]
Summary
Immune Thrombocytopenic Purpura During Maintenance Phase of Acute Lymphoblastic Leukemia: A Rare Coexistence Requiring a High Degree of Suspicion, a Case Report and Review of the Literature. Hacettepe University Faculty of Medicine, Division of Pediatric Hematology, Ankara, Turkey
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