DYSPLASTIC CHANGES IN
IDIOPATHIC THROMBOCYTOPENIC PURPURA AND THE EFFECT OF CORTICOSTEROIDS TO
INCREASE DYSPLASIA AND CAUSE HYPERDPLOD MACROPOLYCTES
Sevgi Y, Lale O, Hamza O, Selim E, Murat T
Division of Pediatric Hematology, Ankara
Oncology Hospital, Ankara, Turkey
Department of Pediatric Hematology, Hacettepe
University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
Objective: In this study
dysplastic hematological changes have been evaluated in Idiopathic
Thrombocytopenic Purpura (ITP) before and after therapy.
Methods: The blood smears of
10 patients in 11 attacks with ITP before and after steroid treatment have
been considered in neutrophil and eozinophil nucleus dysplastic changes,
cytoplasmic granulation status and cell size.
Results: The pretreatment
blood smears of patients with ITP displayed more neutrophils with bizzare
nuclei (p<0.05), Döhle or Döhle-like inclusions (p<0.01),
pseudo-Pelger-Huet-like cells (p<0.01) and nuclei with chromatine
clumping (p<0.01) than the normal children. The eosinophils of ITP
patients were also dysplastic before treatment. The pretreatment diameter
of the neutrophils and the percentage of macropolcytes were greater than
those of the patients with viral infections and normal group (p<0.05 for
all). The percentage of neutrophils with bizzare nuclei with chromatine
clumping and the diameter of the neutrophils and macropolycyte percentage
increased with corticosteroid therapy (p>0.01, <0.01, <0.01 and
< 0.05 respectively). The neutrophil diameter, percentage of
macropolycytes and number of neutrophils with bizzare nuclei decreased
within 1-4 weeks after the therapy was stopped. In the neutrophils of two
patients, diploidy and hyperdiploidy were established before and on the
last day of therapy, respectively and diploidy reversed after therapy was
stopped.
Coclusion: ITP patients display
dysplastic findings in both neutrophils and eosinophils before treatment
and corticosteroids cause transient significant increase in some of the
dysplastic changes in neutrophils.