Download Thrombocytopenia and target cells

From www.bloodjournal.org by guest on May 2, 2017. For personal use only.
bloodwork
IMAGES
IN
HEMATOLOGY
Thrombocytopenia and target cells
● Neil Abramson, Baptist Cancer Institute
A
43-year-old white lawyer was referred for thrombocytopenia with no history of bruising or bleeding. He was a smoker who
denied alcohol consumption and the use of drugs and medications. His spleen was palpable. The family history was negative
for hematologic problems. Laboratory values included a platelet count of 70 ⫻ 109/L, hemoglobin of 111 g/L, and a normal white
blood cell count. The peripheral smear affirmed the moderately decreased platelet count, but many targeted red cells were also noted.
Target cells are seen in a number of disorders, both inherited (hemoglobin C, thalassemia, sickle cell disease, et cetera) and
acquired (usually liver disease). When pressed about the possibility of liver disease because of target cells and an enlarged
spleen, the patient reluctantly admitted to excessive alcohol consumption. Liver enzymes were mildly elevated. The hemoglobin electrophoresis and reticulocyte count were normal, and Coombs test, antinuclear antibodies, and rheumatoid antibody
were negative.
Thrombocytopenia that is associated with liver disease (portal hypertension) is often caused by nonimmune sequestration by
an enlarged spleen. In this patient’s case, the target red cells directed the investigation to the diagnosis.
Many Blood Work images are provided by the ASH IMAGE BANK, a reference and teaching tool that is
continually updated with new atlas images and images of case studies. For more information or to
contribute to the Image Bank, visit www.ashimagebank.org.
798
BLOOD, 1 AUGUST 2007 䡠 VOLUME 110, NUMBER 3
From www.bloodjournal.org by guest on May 2, 2017. For personal use only.
2007 110: 798
Thrombocytopenia and target cells
Updated information and services can be found at:
http://www.bloodjournal.org/content/110/3/798.full.html
Articles on similar topics can be found in the following Blood collections
BloodWork (526 articles)
Information about reproducing this article in parts or in its entirety may be found online at:
http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests
Information about ordering reprints may be found online at:
http://www.bloodjournal.org/site/misc/rights.xhtml#reprints
Information about subscriptions and ASH membership may be found online at:
http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society
of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036.
Copyright 2011 by The American Society of Hematology; all rights reserved.