MORPHOLOGY UPDATE

Thrombocytopenia

Barbara J. Bain* and Ayad Atra

Image 1.

A 12-year-old girl was referred for a specialist opinion, having already had a bone marrow aspiration for investigation ofthrombocytopenia. The platelet count was 9 3 109/l; careful inspection of the blood film showed that, in addition to throm-bocytopenia with large platelets, there were neutrophil inclusions. A diagnosis of May–Hegglin anomaly was made. It is ofcritical importance to examine a blood film before either giving a platelet transfusion or doing a bone marrow aspiration forapparent thrombocytopenia. Sometimes a low platelet count is factitious as a result of platelet aggregation or satellitism.On other occasions the count is true but the film reveals diagnostic clues: giant platelets, neutrophil inclusions, hypogranu-lar or agranular platelets, giant platelet granules or the presence of schistocytes. Neutrophil inclusions are present in theMay–Hegglin anomaly, Sebastian syndrome, and Fechtner syndrome. Hypogranular or agranular platelets are a feature ofthe gray platelet syndrome and of thrombocytopenia due to a GATA1 mutation. Giant platelet granules are seen in Paris–Trousseau thrombocytopenia (Jacobsen syndrome). Observation of red cell fragments suggests that the platelets arebeing consumed, e.g. as a result of disseminated intravascular coagulation, thrombotic thrombocytopenic purpura or vas-cular malformation.

Imperial College Healthcare NHS Trust, St Mary’s Hospital, Praed Street,London, W2 1NY, United Kingdom

*Correspondence to: Barbara J. Bain, Imperial College Healthcare NHSTrust, St Mary’s Hospital, Praed Street, London, W2 1NY, United Kingdom.E-mail: b.bain@ic.ac.uk

Received for publication 28 November 2007; Accepted 29 November 2007

Am. J. Hematol. 83:303, 2008.

Published online 17 January 2008 in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/ajh.21134

VVC 2008 Wiley-Liss, Inc.

American Journal of Hematology 303 http://www3.interscience.wiley.com/cgi-bin/jhome/35105