Keywords:
Megakaryocyte; Emperipolesis; Immune thrombocytopenic purpura
An 11-year-old female presented with fever and thrombocytopenia (Platelet count - 25 × 109/L). Bone marrow smears revealed hyperplasia and emperipolesis in all megakaryocytes containing intact lymphocytes and neutrophils. (Figs. 1 and 2) No etiology was found. The patient was given intravenous immunoglobulin and steroids on presumption of Immune thrombocytopenia, to which she responded well (Platelet count after 4 months-108 × 109/L).
Some emperipolesis may be seen in various disorders, including Immune thrombocytopenia.11 Cashell AW, Buss DH. Frequency and significance of megakaryocytic emperipolesis in myeloproliferative and reactive states. Ann Hematol. 1992;64:273-6.,22 Rai S, Sharma M, Muhary M, Naik R, Sinha R. Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura. Indian J Pathol Microbiol. 2015;52:4523. Aslan D postulated that, in ITP, emperipolesis contributes to megakaryocyte dysfunction and poor response to therapy.33 Aslan D. Emperipolesis in immune thrombocytopenic purpura. Indian J Pathol Microbiol. 2009;52:289-90. This is an unusual case where all megakaryocytes show extreme degree of emperipolesis, yet the patient responded well.
REFERENCES
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1Cashell AW, Buss DH. Frequency and significance of megakaryocytic emperipolesis in myeloproliferative and reactive states. Ann Hematol. 1992;64:273-6.
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2Rai S, Sharma M, Muhary M, Naik R, Sinha R. Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura. Indian J Pathol Microbiol. 2015;52:4523.
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3Aslan D. Emperipolesis in immune thrombocytopenic purpura. Indian J Pathol Microbiol. 2009;52:289-90.
Publication Dates
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Publication in this collection
29 Nov 2021 -
Date of issue
2021
History
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Received
27 Aug 2020 -
Accepted
03 Dec 2020 -
Published
21 Dec 2020