Megaloblastic Erythropoiesis- An Incidental Finding in Idiopathic Thrombocytopenic Purpura

Abstract

Idiopathic thrombocytopenic purpura(ITP) presents as a primary form characterized by isolated thrombocytopenia(platelet count < 100 × 109/L) in the absence of other causes or disorders that may be associated with thrombocytopenia, or a secondary form in which immune thrombocytopenia develops in association with another disorder that is usually immune or infectious. The diagnosis of ITP is usually a diagnosis by exclusion based on a demonstration of peripheral thrombocytopenia, with a history, physical examination, and complete blood count that do not suggest another cause for the thrombocytopenia ITP may affect individuals of all ages, with peaks during childhood and middle aged. Pallor was the most common clinical manifestation of ITP. The pathogenesis of ITP is complex, involving alterations in humoral and cellular immunity. Thrombocytopenia is caused by antibodies that react with glycoproteins expressed on platelets and megakaryocytes (glycoprotein IIb/IIIa, Ib/IX and others), causing shortened survival of circulating platelets and impairing platelet production. Bone marrow examination done in most of the patients. Micro- normoblastic erythropoiesis found to predominate. Megaloblastic erythropoiesis found in 20.3% cases. Megaloblastic erythropoiesis- A finding which can be seen in vitamin B12 deficiency, Anti intrinsic factor or Anti gastric mural cell antibodies and may be associated with other disorders of autoimmunity, the most usual being autoimmune thyroid disorders, type I diabetes mellitus, hypoparathyroidism, Addison's disease, post-partum hypophyseal necrosis, ulcerative colitis and vitiligo. The aim of this study is to correlate Bone marrow aspiration findings and possibility of autoimmunity with Idiopathic thrombocytopenic purpura (ITP).