Analysis Of Clinical Data Of 23 Patients With Acquired Ameakaryocytic Thrombocytopenic Purpura

Objective:To investigate the clinical features, therapy and prognosis of acquired amegakaryocytic thrombocytopenic purpura(AATP). To explore the clinical significance of thrombopoietin, anti-TPO antibody and anti-c-Mpl antibody, and their relationship with peripheral blood platelet counts.Method:Clinical data of inpatient cases undergoing acquired amegakaryocytic thrombocytopenic purpura(AATP) between 2002 and 2009 were collected. Follow-up information on clinical symptoms, therapy effect and prognosis was collected through interview, telephone call and questionnaire. The level of plasma TPO, the optical density of anti-TPO antibody and anti-c-Mpl antibody, platelet counts in 8 patients with AATP,10 patients with ITP and 10 healthy controls were tested by enzyme-linked immunosorbent assay(ELISA) and automatic hemocytoanalyser.Result:28 cases were collected. Follow-up was complete in 23 patients, among which,10 patients were cured,1 patient died of intracerebral hemorrhage,2 patients progressed to aplastic anemia(AA),1 patient progressed to myelodysplastic syndrome(MDS). The cure rate was higher in female than in male, but the difference was not statistically significant(P>0.05). The cure rate in the absence of bone marrow megakaryocyte group was lower than the reduction of bone marrow megakaryocyte group, but it didn't mean the bone marrow megakaryocyte counts could affect the therapy effect(P>0.05). The level of plasma TPO in AATP patients was higher than those in ITP patients and healthy controls, the difference was statistically significant (P<0.05). ITP patients also had higher level of plasma TPO compared with healthy controls, but the difference was not statistically significant(P>0.05). Optical density of anti-TPO antibody in AATP patients was closed to the healthy controls. Optical density of anti-c-Mpl antibody in AATP patients was higher than in healthy controls, but the difference was not statistically significant(P>0.05). The level of plasma TPO in AATP patients was not correlate with PLT counts,optical density of anti-TPO antibody and anti-c-Mpl antibody(P>0.05).Conclusions:Male patients,absence of bone marrow megakaryocyte could be the risk factors of AATP. These patients failed to have a response of routine therapy. The level of plasma TPO in AATP patients was higher than those in ITP patients and healthy controls. The level of TPO could reflect the pathogenesis of thrombocytopenia. It could be able to improve the diagnosis of AATP and guide clinical therapy. The expression of anti-c-Mpl antibody may have a major role in the diagnosis of AATP.