Evaluation of 303 Cases of Thrombocytopenia

Thrombocytopenia is a common clinical problem with many etiological causes. Although transient bone marrow suppression and marrow infiltration by malignancies are important causes, certain non-malignant conditions such as nutritional causes and infections are equally important as the treatment is simple and cure is possible. Depending on the aetiology, the clinical presentation may vary. Knowing the exact aetiology is important for specific treatment and prognostication. A total of 303 cases of thrombocytopenia were studied out of which males were 44% and females were 56%. The patients’ age ranged from 5 months to 84 yrs. The commonest presenting symptom was fever with bleeding manifestations and jaundice. 14% of cases are of Grade 1, 20% of the cases of Grade 2, 5% of cases of Grade 3 and 31% of cases had counts less than 25000/cu.mm i.e. of Grade 4. 50% of cases in Grade 4 had a decreased number of megakaryocytes in the bone marrow. The most common cause of thrombocytopenia in our study was megaloblastic anaemia (48.6%), ITP (20%), post-viral (10.9%) followed by leukaemia, aplastic anaemia and others. Thrombocytopenia has a spectrum of causes which can be diagnosed by detailed history and peripheral smear examination supported by bone marrow examination. Megaloblastic anaemia was the commonest cause of thrombocytopenia followed by immune thrombocytopenia. Unlike in the western India megaloblastic anemia is highly prevalent and is the leading correctable cause of thrombocytopenia. Most of the patients with Grade 4 thrombocytopenia had a decreased number of megakaryocytes in the bone marrow suggesting a production defect.

Chylomicronemia Syndrome–A Rare Metabolic Disorder of Infancy

Chylomicronemia syndrome is a disorder passed down through families in which the body does not metabolize lipids. This causes fat particles called chylomicrons to build up in the blood. It is also known as Familial lipoprotein lipase (LpL) deficiency. Chylomicronemia syndrome occurs due to a rare genetic disorder in which the enzyme LpL is broken or missing and it causes accumulation of chylomicrons. This is known as Chylomicronemia. LpL is normally found in adipose tissue and muscle. It helps in the breakdown of lipids. Symptoms may start in infancy and include: Abdominal pain due to pancreatitis, neurological symptoms, xanthomas and failure to thrive. Peripheral smear showed blasts with normocytic hypochromic anemia and thrombocytopenia and the Refrigeration test was positive. We report 3 cases of Chylomicronemia syndrome in the last 2 years.