Isolated Thrombocytopenia in Thai Children: Etiology and Result of Bone Marrow Aspiration Study

Abstract

Background: Isolated thrombocytopenia (IT) refers to an entity of low platelet count without abnormalities of other lineages. Previous studies revealed that the main cause of IT in children without atypical features i.e. hepatosplenomegaly or adenopathy was immune thrombocytopenia (ITP), while acute leukemia and aplastic anemia (AA) were other possible causes. However, there was no previous study in Thailand to identify the cause of IT.
Objective: To study the bone marrow aspiration (BMA) result in Thai children with IT and to identify the cause of IT in Thai children.
Methods: This was a retrospective chart review of children younger than 15 years old with IT who were diagnosed at Siriraj Hospital during January 1996 to December 2010. All patients had BMA to identify the cause of thrombocytopenia. Demographic data, clinical manifestation, laboratory results including BMA finding, diagnosis, and initial treatment were collected and analyzed.
Results: One hundred and twenty-nine patients were enrolled to the study. All patients had normal or increased megakaryocytes in their bone marrow, and none of them had more than 5% of blast cells. Most patients (97.7%) were diagnosed as acute ITP while 2.3% were diagnosed with neonatal alloimmune thrombocytopenia. None of the patients had acute leukemia or AA.
Conclusion: The BMA result of most patients in this study was compatible to that of ITP, that is none of the patients had acute leukemia or AA. The most common cause of IT in Thai children is acute ITP. This result suggested that BMA in children with IT before starting treatment is not necessary.