CIBERER Murcia Spain

1 Introduction Immune thrombocytopenia (ITP) is an autoimmune disorder characterised by a low platelet count (PC) leading to purpura and bleeding episodes. It results from immune dysregulation with autoantibody-mediated platelet destruction [1]. ITP is classified as primary, when no underlying cause is identified, or secondary, when associated with factors such as medicines, autoimmune diseases like systemic lupus erythematosus, or infections such as HIV [1].

A 76-year-old male with a history of localised pelvic radiotherapy for prostate cancer 6 years earlier presented with fatigue and severe pancytopenia (haemoglobin 80g/L, normocytic; platelets 50 × 109/L; leucocytes 1.5 × 109/L; neutrophils 0.3 × 109/L; no peripheral blasts). Bone marrow aspiration was hypercellular for age with erythroid hyperplasia and striking trilineage dysplasia. Erythroid precursors displayed nuclear irregularities, megaloblastoid changes and multinuclearity.