Is bone marrow examination justified in idiopathic thrombocytopenic purpura?
D. S. Halperin and J. J. Doyle
Division of Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario.
Bone marrow examination is widely accepted among pediatric hematologists as
a mandatory investigation in childhood idiopathic thrombocytopenic purpura
(ITP). The aim of this procedure is to confirm the presence of
megakaryocytes and to exclude other conditions, such as leukemia and
aplastic anemia. To assess the need for bone marrow examination, we
reviewed the charts of 127 children with presumed ITP and found that bone
marrow examination led to a different diagnosis in five (3.9%) of them. All
five patients had presented with clinical and/or laboratory features
atypical of acute ITP; none had leukemia. The initial clinical and
laboratory findings of 50 patients with aplastic anemia also were reviewed;
all had features atypical of acute ITP. Proper history and physical
examination as well as a complete blood cell count are reliable means of
recognizing patients with typical vs atypical features of ITP. Bone marrow
aspiration could be limited safely to those patients with atypical features
of ITP or to patients being treated with corticosteroids.
