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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 452-453
Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura


Department of Pathology, Kasturba Medical College, Mangalore, India

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Date of Web Publication12-Aug-2009
 

How to cite this article:
Rai S, Sharma M, Muhary M, Naik R, Sinha R. Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura. Indian J Pathol Microbiol 2009;52:452-3

How to cite this URL:
Rai S, Sharma M, Muhary M, Naik R, Sinha R. Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Dec 16];52:452-3. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/452/55032


Sir,

This is with reference to article by Dr. Seema Sharma and Dr. Amit Rawat in Indian Journal of Pathology and Microbiology 2006;49 (4):631. The observation made in the article was of interest to us.

We had also conducted a prospective study on 144 bone marrow aspirates of cases with thrombocytopenias which included 19 cases of idiopathic thrombocytopenic purpura. Emperipolesis was seen in 13 out of 19 cases (68.4%) [Figure 1]. In 5 cases, lymphocytes were seen within megakaryocytes, 4 cases showed lymphocytes and nucleated red blood cells (nRBCs), 2 cases showed lymphocytes, nutrophils and nRBCs, 2 cases showed nRBCs and one case showed lymphocytes and nutrophils within the megakaryocytes. These findings correlated with the claim of Rozman C. and Vives Corrons JL [1] of a considerable increase in megakaryocytic emperipolesis in idiopathic thrombocytopenic purpura (ITP).

We also found that megakaryocytes in ITP exhibited presence of immature forms in all 19 cases (100%). Decreased platelet budding was seen in 12 cases (63.2%) while cytoplasmic vacuolization was seen in 9 cases (47.4%). These observations were similar to Larson L [2] who pointed out that megakaryocytes in ITP had large cytoplasmic mass, decreased platelet budding and cytoplasmic vacuoles. These changes reflect increased megakaryocyte turnover and not abnormal morphology.

Apart from idiopathic thrombocytopenic purpura, emperipolesis was also seen in our study in megaloblastic anemia, aplastic anemia, infection associated thrombocytopenias, hypersplenism, myelodysplastic syndrome, acute myeloid leukemia, acute lymphoblastic leukemias, myeloma and lymphoma-leukemia syndrome.

Exact mechanism of emperipolesis is unknown. Its long been postulated that cells migrate into the cavities of demarcation membrane system, which opens onto the exterior. [3] Animal studies conducted have suggested that megakaryocytic emperipolesis is dependent on adhesion molecules via lymphocyte function associated antigen 1(LFA-1) and intercellular adhesion molecule 1(ICAM-1). [4] However further studies need to be conducted to clarify the exact mechanism.

 
   References Top

1.Rozman C, Vives-Corrons JL. On alleged diagnostic significance of megakaryocytic phagocytosis (emperipolesis). Br J Haematol 1998;48:510.  Back to cited text no. 1    
2.Larson L. Disorders of primary hemostasis. In: McKenzie SB, Clinical laboratory Hematology. 1 st ed. New Jersey: Pearson Prentice Hall; 2004. p. 703-8.  Back to cited text no. 2    
3.Breton-Gorius J. On the alleged phagocytosis by megakaryocytes. Br J Haematol 1981;47:635-6.  Back to cited text no. 3  [PUBMED]  
4.Tanaka M, Aze Y, Fujita T. Adhesion molecule LFA-1 / ICAM-1 influence on LPS induced megakaryocytic emperipolesis in rat bone marrow. Vet Pathol 1997;34:463-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Sharada Rai
Department of Pathology, Kasturba Medical College, Mangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55032

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