Morphologic evaluation of megakaryocytes in immune thrombocytopenia patients older than 80 years

OBJECTIVE: In immune thrombocytopenia (ITP), which is a common acquired bleeding disorder, cytotoxic T-cell-mediated cellular immune response against both circulating platelets and bone marrow megakaryocytes are the most important mechanisms in the pathogenesis.
METHODS: In our study, we evaluated the features of 33 patients with ITP, over 80 years of age.
RESULTS: The median age of the patients was 90, 15 patients were female (45.4%). The mean platelet count of the patients was 39×109/L and the mean mean platelet volume was 10,33fL. Twelve patients had a target thrombocyte count greater than 30×109/L, while 20 patients had a target platelet count of 75×109/L or greater with an absolute indication of antiaggregation. In the environmental spread, 18 dysplasia findings were observed.
CONCLUSION: Morphologic observations suggesting dysplasia including micromegakaryocytes and a non-dysplastic but dysmegakaryopoietic finding, multiple segmented nuclei may be related to the degree of thrombocytopenia and response to treatment. Likewise, nondysplastic features including immature forms, emperipolesis, bare nucleus, hypolobulation, and hypersegmented nucleus were related to the degree of thrombocytopenia.

80 yaþ üstü immün trombositopeni hastalarýnda megakaryositlerin morfolojik deðerlendirilmesi

Giriþ: Yaygýn bir edinsel kanama bozukluðu olan immün trombositopenide (ÝTP), hem dolaþýmdaki trombositlere hem de kemik iliðinde megakaryositlere yönelik oluþan sitotoksik T hücre aracýlý hücresel immün yanýt patogenezdeki en önemli mekanizmalardandýr.
Yöntem: Çalýþmamýzda 80 yaþ üstü 33 ÝTP'li hastanýn özelliklerini deðerlendirdik.
Sonuç: Hastalarýn ortanca yaþý 90, 15'i kadýndý (%45,4). Hastalarýn ortalama trombosit sayýsý 39 x109/L, ortalama trombosit hacmi ortalama 10,33fL idi. On iki hastada hedef trombosit sayýsý 30x109/L'den fazlayken, 20 hastada mutlak antiagregasyon endikasyonu ile 75x109/L veya daha yüksek hedef trombosit sayýsý vardý. Periferik yaymada 18 hastada displazi bulgusu gözlendi.
Sonuç: Morfolojik olarak displaziyi düþündüren ancak displazi bulgusu olmayan çok sayýda çekirdek içeren Megakaryositler ve dismegakaryopoietik bir bulgu olan mikromegakaryosit bulgularý trombositopeninin derecesi ve tedaviye yanýt ile iliþkili olabilir. Benzer þekilde immatür formlar, emperipolez, çýplak nükleus, hipolobulasyon ve hipersegmente nükleus gibi displastik olmayan özellikler de trombositopeni derecesi ile olduðu görüldü. (NCI-2022-5-17/R1)